Partners in Play:

1. Partners in Play: Promoting Health Through Filial Play Therapy Presented by Diane Kukulis, ACSW, LMSW, RPT-S “To grow up to be healthy, very young children do not need to know how to read, but they do need to know how to play.” Fred Rogers

2. WHY PLAY?

3. WHY PLAY?

4. WHY PLAY? • WE LEARN 10% OF WHAT WE READ • WE LEARN 20 % OF WHAT WE HEAR • WE LEARN 30% OF WHAT WE SEE • WE LEARN 50% OF WHAT WE SEE AND HEAR • WE LEARN 70% OF WHAT WE SAY • WE LEARN 90% OF WHAT WE SAY AND DO David Kolb

5. The Case for Play (Experiential Learning) If We Learn 50% of what we SEE and HEAR and 90% of what we SAY and DO then (do the math ) Consider the Learning Potential from what we See, Hear, Say and Do!!! THIS IS PLAY!

6. WHAT IS PLAY? Play is a rite and a quality of mind in engaging with one's worldview. Play may consist of amusing, pretend or imaginary interpersonal and intrapersonal interactions or interplay. The rites of play are evident throughout nature and are perceived in people and animals, particularly in the cognitive development and socialization of children. Play often entertains props, animals, or toys in the context of learning and recreation. Some play has clearly defined goals and when structured with rules is entitled a game. Whereas, some play exhibits no such goals nor rules and is considered to be "unstructured" in the literature. Wikipedia

7. WHAT IS PLAY? “It is a state of being that is intensely pleasurable. It energizes and enlivens us. It eases our burdens, renews a natural sense of optimism and opens us up to new possibilities. These wonderful, valuable qualities are just the beginning of what play is. Scientists - neuroscientists, developmental biologists, psychologists, scientists from every point on the scientific compass - have recently begun viewing play as a profound biological process. They are learning that play sculpts our brain; it makes us smarter and more adaptable.  For many animal species it has evolved over eons with result that the most advanced animals play the most i.e., play is more central to their development. Humans are the biggest players of all, specially designed by nature to play throughout our long lives.” Stuart Brown, MD; National Institute for Play

8. WHAT IS PLAY? • Play brings mind, body and spirit together into one, unified whole. It is: • Intrinsically motivated - an end in itself; done for the satisfaction of doing it. • Freely chosen - there are no imposed rules; no demands or requirements to engage in it. • Pleasurable - it must enjoyed and not be a source of stress. • Non-literal - it involves make-believe that accommodates the interest of the player. • Active and engaging - dominated by the players; players are not indifferent or passive. Smith and Vollstedt, 1980

9. Play Therapy Defined • The Association for Play Therapy defines play therapy as: "The systematic use of a theoretical model to establish an interpersonal process wherein trained play therapists use the therapeutic powers of play to help clients prevent or resolve psychosocial difficulties and achieve optimal growth and development."

10. The Therapeutic Power of Play Schaefer POWER FACTORPOSITIVE OUTCOME OVERCOMING RESISTANCE ››››››› COOPERATION COMMUNICATION ››››››› UNDERSTANDING COMPETENCE/MASTERY ››››››› SELF-ESTEEM CREATIVE THINKING ››››››› NEW SOLUTIONS TO OLD PROBLEMS CATHARSIS ››››››› EMOTIONAL RELEASE ABREACTION ››››››› ADJUSTMENT TO TRAUMA ROLE-PLAY ››››››› ACQUIRE NEW BEHAVIORS FANTASY ››››››› ENLARGES POSSIBILITIES METAPHORIC TEACHING ››››››› INSIGHT ATTACHMENT FORMATION ››››››› PLEASURE IN CONNECTEDNESS RELATIONSHIP ENHANCEMENT ››››››› INTIMACY W/ SELF & OTHERS POSITIVE EMOTION ››››››› EGO BOOST GAME PLAY ››››››› POSITIVE SOCIAL RELATIONSHIPS DEVELOPMENTAL MASTERY ››››››› COGNITIVE AND EMOTIONAL GROWTH ››››››› IN ALL DOMAINS

11. Play Therapy Defined • In The Play Therapy Primer, Kevin O’Connor defines play therapy as: “…a cluster of treatment modalities that include a variety of highly developed theoretical orientations and technical strategies. … all play therapy shares a common goal: the reestablishment of the child’s ability to engage in play behavior as it is classically defined…. ….Play therapists universally recognize that treatment has been successfully completed when the child demonstrates an ability to play with joyous abandon – this is what makes play therapy unique.”

12. …engaging with one's worldview …energizes and enlivens …opens up possibilities …profound biological process …sculpts our brain …makes us smarter and more adaptable Intrinsically motivated Freely chosen Active and engaging Cathartic Enlarging possibilities Enhancing intimacy Ego boosting Developmental mastery “…To Engage in Play (as it is classically defined)With Joyous Abandon…”

13. Child-Centered Play Therapy Filial Play Therapy Theraplay Short-Term Play Therapy Sandtray/Sandplay Therapy Gestalt Play Therapy Cognitive-Behavioral Play Therapy Prescriptive Play Therapy Adlerian Play Therapy Ecosystemic Play Therapy Group/Dyadic Play Therapy Developmental, Individual, Relationship Based Model Types of Play Therapy

14. Key Concepts of Child-CenteredPlay Therapy THE PRIMARY GOAL IS THE DEVELOPMENT OF SELF-AWARENESS AND CHOICE “First, do no harm.” -me • Children are unique and worthy of respect • Children are resilient • Children have an inherent tendency toward growth and maturity • Children are capable of positive self-direction “Birds fly, fish swim, and children play.” -Gary Landreth

15. What Children Learn • To respect themselves • To identify their feelings and know their feelings are acceptable • Self-control • To assume responsibility for themselves • To be creative and resourceful in confronting problems • Self-direction • To accept themselves • To make choices and to be responsible for their choices

16. Principles of Child-Centered Play Therapy Axline, 1969 1. The therapist develops a warm, friendly relationship with the child with a focus on establishing rapport. 2. The therapist accepts the child’s expressions, feelings and choices exactly as they are. 3. The therapist establishes a feeling of permissiveness in the relationship so that the child feels free to express his/her feelings completely. 4. The therapist is alert to the feelings and themes the child is expressing and reflects those back to the child so that s/he feels understood and can better learn about his/her emotions and behavior.

17. Principles of Child-Centered Play Therapy Axline, 1969 5. The therapist maintains a deep respect for the child’s ability to solve his/her own problems, refraining from giving advice or doing for the child. The responsibility to make choices and to institute change is the child’s. 6. The therapist does not direct the child’s actions or conversation in any manner. The child leads the way. 7. The therapist does not hurry or rush the child. The process is gradual and the therapist is patient. 8. The therapist establishes only those limitations that are necessary to maintain safety and to make the child aware of his/her responsibility in the relationship.

18. Following the Child’s Lead Mirroring, Tracking, Reflection, and Interpretation focused on: • Person rather than Problem • Present rather than Past • Feelings rather than Thoughts or Acts • Understanding rather than Explaining • Accepting rather than Correcting • Child’s Direction rather than Therapist’s Instruction • Child’s Wisdom rather than Therapist’s Knowledge

19. That’s where you wanted it. That’s how you…. You know how to….. You know what to do with that. You’re figuring out what that is. That’s your plan. You made it happen just like you said. That’s how you wanted it. You’re going to pick. You know how that works. You know what you like. You’re showing me how. You did it. You know all about it. You’re curious about that. You try and try and don’t give up until you figure it out. That was hard but you did it. You can take care of yourself. You worked hard on that. You fixed it. The Language of Reflection

20. What is Filial Play Therapy? • The word ‘Filial’ originates from Latin word meaning ‘son’. Greek word referred to ‘love of a gentle nature’. • Developed in the late 50’s/early 60’s by Bernard and Louise Guerney. • Grounded in child-centered play methods developed by Axline, Dorfman, and Moustakis. • Child-centered play therapy skills are taught to parents (or paraprofessionals) so they may be translated to the home (or school) environment.

21. Why Teach Parents to be Therapeutic Play Partners? • Effective with a wide variety of behavioral and emotional issues – the focus is not on the issue but on enhancing the interaction and strengthening the relationship between parent and child. • Meta-analysis of filial research (22 studies) indicates that it is highly effective (ES=1.15) • Utilizes lower limit control (strategies that center on exploration and incorporation of new ideas) as opposed to upper limit control (strategies that center on the implementation of limits imposed by self or others).

22. Why Teach Parents to be Therapeutic Play Partners? • Enhances and optimizes resiliency – provides ‘one empathic other’ and supports/strengthens the development of the child’s inner resources to resolve problems or distress. • Research indicates long term changes in the quality of relationship between parent and child. • Children love it! Play is a normal/preferred means of self-expression for children. • Parents tell us it is helpful in developing a better understanding their children.

23. Goals of Filial Play Therapy • For the Child: • Better understand own and others’ feelings • Learn to appropriately express feelings • Reduce inappropriate behavior • Increase trust in parents • Test limits and problem-solving in a safe environment • Increase self-confidence and self-esteem • Promote mastery of skills

24. Goals of Filial Play Therapy • For the Parents • Increase understanding of their child’s development • Increase understanding of their child’s feelings and motivations • Improve communication • Increase feelings of warmth and trust in children • Improve self-confidence • Reduce parental frustration • Learn skills to be used in everyday situations

25. Goals of Filial Play Therapy • For the Family • Strengthen parent-child relationship • Strengthen family ties and commitment • Improve family communication skills • Improve family coping capacities • Increase positive family interactions • Prevent/reduce future family problems (resiliency) The family that plays together stays together!

26. 1. The parent develops a warm, friendly relationship with the child with a focus on establishing rapport. 2. The parent accepts the child’s expressions, feelings and choices exactly as they are. 3. The parent establishes a feeling of permissiveness in the relationship so that the child feels free to express his/her feelings completely. 4. The parent is alert to the feelings and themes the child is expressing and reflects those back to the child so that s/he feels understood and can better learn about his/her emotions and behavior. 5. The parent maintains respect for the child’s ability to solve his/her own problems, refraining from giving advice or doing for the child. The responsibility to make choices and to institute change is the child’s. 6. The parent does not direct the child’s actions or conversation; the child leads the way. 7. The parent does not hurry or rush the child. The process is gradual and the therapist is patient. 8. The parent establishes only those limitations that are necessary to maintain safety and to make the child aware of his/her responsibility in the relationship. Principles of Filial Play Therapy

27. Assessment/Treatment Planning: 1-2 sessions Information gathering from parents Drawing or play assessment with child Rapport Building: 3-4 sessions Non-directive play sessions to get to know child and assess their response to non-directive play Parent Training Sessions: 2-3 sessions Didactic review of play skills and role-play Supervised Parent-Child Play Sessions: 6-8 sessions (can be more) 25-30 minutes of play and 25-30 minutes of processing with parent Home Play Sessions w/ Check-Ins: Approximately monthly Address issues concerns re: home sessions (but varies greatly) and explore strategies for expanding the use of the skills in day- to-day situations. Basic Structure to Filial Play Therapy

28. A Word About Toys Toys should be: • safe • cleanable • without a prescribed structure/story (avoid too many popular action figures; they will promote imitative play) • interesting • facilitate a range of creative and emotional expression • allow exploration and expression without verbalization • not so precious/noisy/messy that it pushes buttons or much time is spent setting limits “Toys should be selected, not collected”Gary Landreth

29. Family/Nurturing Toys Human/animal families Doll house w/furniture Baby doll w/ clothes/acces. Dress-up clothes Fake food/dishes Doctor kit w/bandaids Puppets Expressive Toys Playdoh or clay Sand/rice tray w/ miniatures Scarves and bandannas Chalk or dry erase board Mirror Magic wand Play telephone Recommended Toys

30. Construction Toys Cardboard or wood blocks Blankets, sheets, pillows, etc. Paper, crayons, glue Paper plates, cardboard Cardboard/wooden blocks Aggression Related Toys Bop bag or Dart gun or dart board Soldiers Foam bat or pool noodle Rubber knife Miscellaneous Toys Cars, trucks, safety vehicles Ring-/beanbag-toss game Playing cards Play money Assorted cups, bowls, containers, spatulas, etc. Lined tablets w/pencils Crafting supplies - yarn, beads, foamboard, Sculpey, clothespins, cardboard boxes, etc. Recommended Toys

31. Filial Play Therapy Skills CREATING THE THERAPEUTIC ENVIRONMENT The Four Skills: • Structuring Skill • Sets the overall tone and format of the sessions. • Empathic Listening Skill • Shows sensitivity, acceptance and understanding. • Imaginary Play Skill • Promotes free expression and promotes elaboration of play themes. • Limit Setting Skill • Creates a safe, protected environment and promotes self-responsibility.

32. Structuring Skill Establishes a framework within which the play sessions take place. Communicates to the child that this time is special and different from the rest of their lives and that the “rules” are different. • Introductory Message: (encourage memorization) “______, this is a very special play time (room). You can do almost anything you want to during this time. If there is something you may not do, I will let you know.” “It is time for our special playtime now.” • Bathroom Break: Recommend that child use the bathroom prior to the play session. However, ONE bathroom break is allowed during the play session. After the child returns, the parent states: “You are back in our special playtime now.”

33. Structuring Skill • Playroom Departure: The parent gives a five minute warning (this can be varied, depending on the need of the child). “________, we have five more minutes of special playtime today.” Then, a one minute warning is given: “________, we have one minute left to play today.” At the end of the playtime, parent pleasantly, but firmly states: “_______, our playtime is up today. We need to leave our playspace.” If the child resists leaving, the parent reflects the child’s feelings and then restates that the session is finished with a firm tone of voice. If the child continues to resist the parent firmly leads the child out of the space. It is very important that the session ends clearly and without delay; this established boundaries for the play time and parental authority.

34. What About the Clean-up? In filial play therapy sessions the child is not expected or asked to clean up. • Resistance or a power struggle over clean-up can undermine parental authority and the therapeutic process. Enforcement focuses on ending the session as that is easier to enforce. • Free expression of feelings may be inhibited if the child is thinking about the clean-up, especially in an anxious child. Some children will choose to clean-up at the five-minute or one minute warning. This is OK but it is still important to end the session when the time is up. Establishment of clear boundaries for the playtime is fundamental.

35. Empathic Listening Skill Parents try to view the world from their child’s point of view and put their own feelings and thoughts on hold. • Undivided Attention and Interest Parents pay close attention to the child’s expressions and feelings with genuine curiosity. • Verbal Tracking Play by play commentary similar to what is done by sportscasters when describing a game in action. It is important to be attuned to the feelings observed and mirror them back to the child. Actions and the feelings associated can be tracked.

36. Empathic Listening Skill • Do not ask questions. Do not lead the child. Questions and directions can interrupt and shift the play away from where the child was going. It can also cloud the parent’s capacity to understand the themes played out. • Do not assist the child any more than necessary to keep them engaged in their play process. This can be very difficult. It can be painful to watch a child struggle with a task and not step in to ‘help’. Verbal tracking in the form of “You are working very hard on that”, or “You are figuring out how that works” will promote a sense of mastery and competence. If the child becomes overwhelmed or demanding of help, the parent can ‘partner’ with the child as ‘part of the team’ or as a ‘helper’.

37. Empathic Listening Skill • If the child asks a question: (“What’s this for?” or “What do you want to do?”) 1st) Reflect the question – “You’re trying to figure that out.” or “You’re thinking about what to do.” 2nd) If child persists: “In our special playtime you can use that just about any way you’d like.” or “This is special playtime and you get to choose what to do.” 3rd) If child still persists, provide a simple answer but return the decision to the child: “Some people might use it as a wagon but you can use it just about any way you’d like.” or “There are blocks or games to play with but this is special playtime and you can choose what to do.”

38. Empathic Listening Skill • If the child states: “Stop copying me!”: • Make sure you are varying your verbal tracking reponses. • Explain that what they are doing is very important and you are trying to make sure that you understand him/her. • Refrain from the play by play tracking and reflect feelings only. • Stop reflecting aloud and show interest nonverbally for awhile.

39. Imaginary Play Skill • There will be times when parents are invited into their child’s play. Parents should be responsive to the invitation and do their best to play out the role assigned to them. Some children will be more specific and demanding than others. There are some general guidelines that inform the imaginary play skill:

40. Imaginary Play Skill • Be accepting and act out the role assigned to you within the limits of safety and appropriateness. • The child is the director of the play and you are the actor. • Once you have been assigned a role you no longer need to use empathic listening/verbal tracking; you shift back when the child shifts out of imaginary role playing. • It is OK to shift out of imaginary play to clarify what the child is wanting from you. “Do you want me to fight back or give up?”

41. Limit-setting Skill • Provides for parent and child safety through the establishment of boundaries. • Establishes parental authority. • Promotes behavioral responsibility in child. • There is a 3-Step sequence to the limit-setting process.

42. Limit-setting Skill • Limits should be kept minimal. • Fosters the child’s ability to remember/comply • Safety should be a primary consideration in setting limits. • Limits must be clear and consistent. • Reduces/minimizes ‘testing’ behavior • Consequences are the same for all broken limits: The child must leave the playspace and the session is ended.

43. Limit-setting Skill Limits may include the following: • No throwing of toys or play items. • Crayons/markers on appropriate surfaces only (paper, cardboard, etc.) • No poking with sharp objects. • No intentional destruction of toys. • Personal parental limits as determined by parent in collaboration with therapist (no pointing guns at real persons, no abusive language, etc.)

44. Limit-setting Sequence • State the Limit • Brief, clear, specific, firm. • Use the child’s name, reflect the child’s desired behavior, state the limit, restructure/redirect the play. • “Stevie, you’d like to hit me with the rubber bat. Remember I told you if there was something you could not do. You may not hit me with the rubber bat. You can do just about anything else.”

45. Limit-setting Sequence If Limit is broken: • Give a Warning • Restate the limit, state what will happen if the limit is broken, restructure/redirect the child’s play. • “Stevie, remember I told you that you may not hit me with the rubber bat? If you hit me with the bat again we will have to end our special playtime for today. You may do just about anything else.”

46. Limit-setting Sequence If the limit is again broken: • Enforce the Consequence • Restate the limit, carry out the consequence in a firm but pleasant manner by leading the child away from the playspace. • “Stevie, I told you if you hit me with the rubber bat we would have to end our special play for today. Since you hit me again we have to end.” This procedure helps the child learn that s/he is responsible for his/her choices and behavior and that the outcome is predictable and dependable.

47. Control Power Expression of feelings Problem-solving Trauma Rescue Family relationships Good vs. evil Developmental mastery Sacred vs. profane Winning and losing Wishes and dreams Friendship Dependency Loyalty binds Memories Competency vs. cheating Trust and betrayal Nurturance vs. neglect Aggression and violence Grief and loss Peer relationships Common Play Themes

48. Play Themes Indicators • Repeated play with the same toys or storyline. • Sudden/abrupt changes or shifts in play. • Intense, lengthy or highly focused play. • ‘Secret’/‘Silent’ play. • Play is consistent or similar over sessions (may use different toys) or storyline picks up where previous session left off. • Play from previous sessions is referred to by child.

49. Play Themes • A Special Word About Aggression and Violence: Violence is uncontrolled and destructive aggression. Aggression is a natural part of human development; it involves the release of energy and can be useful. Our task is to figure out how to express it without doing harm. Play is a natural way to practice aggressive behavior and determine what strategies are a best fit for various situations. Structuring and limit-setting skills provide safe boundaries for aggression to be expressed in a non-destructive manner.

50. Processing Sessions with Parents • How did it feel for you? • How do you think your child was feeling? • Was there anything that surprised you? • Do you see any parallels in the play to your child’s real life? • How did the intense (aggressive, chaotic, fearful, etc.) play feel for you? • What parts of the session were hardest for you? (Boring, scary, anxiety provoking, etc?) • What parts of the session were most satisfying for you? • Why do you think is was so hard (boring, scary, anxiety provoking/satisfying for you?