Transcript HERE - Buncombe County Schools

Integrating Brief, Strength-based
Therapy and Play
(A.K.A Play! Play! We Don’t
Have All Day!”)
Heather Thompson
Assistant Professor of Counseling
Western Carolina University
Context
Practice
• Practice
• Theory
Theory
Research
• Research
Integrating Brief and Play
Therapy
Practice & Theory
Self-concept
• Trauma
• Skills
• Self-concept
• Self-efficacy
Thoughts
about self
Feelings
about self
• Mastery and competence
• SFBT and Play Therapy
Behaviors
and Choices
Research
• Time
• Resources
• Space
• CBT & SFBT
• Social skills
• 5-10 hours group
Today’s Journey
• How is play compatible?
• Why integrate play?
• How to integrate play and brief
therapy
• How to assess growth and
development
Solution-focused brief
therapy (SFBT)
Non-directive play
therapy (NPT)
Focus on the present
Focus on the present
Build on strengths
Build on strengths
Help children experience
Help children experience positive
positive behaviors
behaviors
Build self-efficacy
Build self-efficacy
Compatibility
Solution-focused brief
therapy (SFBT)
Non-directive play therapy
(NPT)
• Establish and work toward
• Promote decision-making and self-
goals
• Promote behavioral change
responsibility
• Enhance frustration tolerance
• Facilitate emotional regulation &
impulse control
• Facilitate understanding and
expression of emotions, intentions,
Why
Integrate
Play?
wants, desires
• Promote understanding of the
connection between emotions,
intentions, reactions, and behaviors
http://www.youtube.com/watch?v=_4ovwAdxCs0
Why Integrate Play?
Evidence-based (school counseling with
elementary-aged children)
• 16 sessions decreased ADHD and anxiety symptoms
(Ray, Schottelkorb, & Tsai, 2007)
• 14 sessions decreased behavioral problems
(Ray, Dee, Blanco, Sullivan, & Holliman, 2009)
• 10 sessions improved internalizing and externalizing reported
by teachers and parents (Flahive & Ray, 2007)
• 8 sessions for academically at-risk increased academic
achievement (Blanco & Ray, 2011)
• 6 sessions increased self-efficacy
(Fall, Balvanz, Johnson, & Nelson, 1999)
• 4 sessions increased self-esteem and internal locus of control
(Post, 1999)
Why Integrate Play?
• Developmentally appropriate
– Trust, autonomy (self-control), initiative (power), and
industry (confidence)
– Unable to verbally express complicated emotions [guilt,
shame, resentment] and how they are affected by them
– Young children can feel, but they cannot analyze their
feelings and thoughts
– Metacognition (knowledge about our cognitive processes
and how to regulate them – choosing “the right tool for
the job”) is limited
Why Integrate Play?
• Assimilate experience through symbolic
play
Play + imagination = re-enactment and reorganization
of the original experience
Memories are altered each time they are revisited and
that alteration is influenced by the impact of the
present moment
(Levy, 2008)
Multimodal Integration
Left Hemisphere
Explicit Language-based
Knowledge
Language, speech, analytical
thinking and sequential
processing, and the
process of creating
narrative
Right Hemisphere
Implicit Sensory-based
Knowledge
Intuition, emotions, sensory,
automatic skills, and
creativity
Various modalities by which the brain constructs and stores experiences. Play
engages two main forms of cognition: explicit and implicit thought.
Play accesses non-verbal sensory-based knowledge and stimulate the left
and right hemispheres and integration of knowledge
(Fosshage, 2004; Kay, 2009; Lyons-Ruth, 1999; Pally, 2005)
Implicit Cognitions
• Are not easily described with words
• Occur outside of our awareness because they are not embedded in a
narrative
• Do not require cognitive mediation through the cortex
• Are not consciously recallable until integrated with explicit cognition
• Early attachment experiences become implicit memories
• Become relational patterns that influence future relationships
• Play allows for the restructuring of implicit attachment issues
• Play facilitates integration
Mirror Neurons & PerspectiveTaking
Observe
Neurons
fire (as if)
Affective
resonance
Empathy
• Early life trauma decreases capacity for perspective-taking
• Hypothesize that this may be due to failure or underdevelopment of Mirror Neurons
(Fogerty, 2009 ; Iacoboni 2005; Rizzolati & Craighero 2004; Wolf et al. 2001)
Brain Derived Neurotrophic
Factor (BDNF)
• Chemical compound that prevents
cell death and facilitates growth of
new neurons
• Reduced by chronic stress and
depression
• Increased by play therapy
(Gordon et al., 2003; Kolb & Wishaw 2003)
Why Integrate Play?
– Self-control (emotional regulation, attention
control, impulse control)
– Self-efficacy (self-esteem, confidence)
– Social skills (consideration for others, reading
social/emotional cues, perspective-taking)
(Arnold, Kupersmidt, Voegler-Lee, & Marshall, 2012; Brody, Flor, & Gibson, 1999; Jimerson, Egeland, Sroufe, &
Carlson, 2000; McLelland, Morrison, & Holmes, 2000; Raver & Zigler, 1997; Vidal, Rodeiro, Emery, & Bell, 2012;
Vitaro, Laroque, Janosz, & Tremblay, 2001; Von Suchodoletz A, Gestsdottir S, Ragnarsdottir H, et al., 2013)
Why Integrate Play
• Assess real-world application
• Freeze-frame
How to integrate
• 35 minute session
• 15 structured exercise
–
–
–
–
Developing goals
Monitoring success
Teaching skills
Practicing skills
• 20 non-directive play therapy
– Multimodal integration
– Real-world application
– Freeze-frame
SFBT Goals
Establish and work toward goals
Establish and work toward goals
Promote behavioral change
Build on strengths
Build self-efficacy
Build on strengths
Build self-efficacy
Promote behavioral change
Build self-efficacy
Promote behavioral change
Corresponding SFBT Techniques
Miracle question:
“A miracle happens while your asleep…”
Specific, concrete, behavioral goals:
“What would you be doing differently if you weren’t
feeling so sad?”
“What would others notice if you weren’t feeling so
sad?”
“How would others respond to you if you weren’t
feeling so sad?”
Exceptions:
“Tell me about a time when you experienced a small
miracle?”
Scaling questions:
“Rate your success on a scale of 1-10.” “How come it
was a 5 and not a 4?” “What can you do to make it a
6?”
Positive reinforcement:
Acknowledging efforts, reminding the child of past or
unacknowledged successes, and encouraging child to
think of ways to move up the scale – “Wow and How”
NPT Goals
Corresponding NPT
Techniques
Conscious awareness of emotions,
intentions, needs, etc.
Reflecting feelings, prosocial
behaviors, intentions, and meaning
Draw on strengths & builds self-efficacy
Reflecting success, exceptions, and
positive changes
Build self-efficacy & enhance frustration Facilitating esteem and
tolerance
encouragement FEE
Promote decision-making and build self- Facilitating decision-making and selfefficacy
responsibility FDR
Facilitate emotional regulation and
impulse control & promote decisionmaking and self-responsibility
Limit setting LS
http://www.youtube.com/watch?v=JIMWOOlR_9g
Play Therapy Techniques
AA – acknowledging nonverbal behaviors
RF – reflecting feeling, intentions, experiences,
needs, wants, hopes, and desires
FEE – facilitating esteem-building and
encouragement
FDR – facilitating decision-making and
responsibility
LS – limit setting
Tracking - Labeling Toys
• Avoid labeling toys
– Reasonable to label clearly defined toys
• Children will often correct you
– “It’s not a dog. It’s a baby.”
• Be non-gender-specific
– “You’re showing it who’s the boss.”
Tracking
• Octavious pushes a truck across the
sandbox.
• Celia scoops up sand and puts it in a
bowl.
• Ashley gets up and begins looking
around the room.
Reflecting Feelings
• Avoiding leading, influencing, or judging
– “I wonder what would happen if the mean witch was
nicer to the children?”
– “You seem angry with the puppy. I wonder how that
little dog feels?”
– “You want other people to be nice to you when you’re
sad, but you’re mean to the doll when it cries.”
Reflecting Feeling, Meaning,
Intentions
• Ashley: Begins to write on the chalk board. “I like to draw on
the board, but my teacher said the board is just for her.”
– You wish you could draw on the board too.
• Ashley: Looks at you with her hands on her hips and says,
“We don’t get to play when we want to either. We have to do
what the teacher says.”
– It’s frustrating when you can’t play when you want to.
• Ashley: Picks up the bubbles and smiles. She blows a bubble
and laughs.
– You feel happy when you blow bubbles.
Facilitating Decision-making
• Avoid giving advice, hints, suggestions
– “Maybe if you put the other end in first it would fit.”
– “I’m sure you’ll figure it out if you keep trying.”
– “I wonder what would happen if you flipped it over.”
Facilitating Decision-Making
• Celia: Enters the playroom, looks around the room, and says: “What
should I do?”
– In here, you get to decide. You can play with the toys in many of the
ways that you might like to.
• Celia: Picks up a crayon and piece of paper and says: “I know what I
can do.”
– You figured it out. You know exactly what you want to do.
• Celia: Begins to draw and says: “I’ll make a birthday card for Jess.”
– You’ve decided to make a card for your friend.
• Celia: “What colors should I use for my rainbow?”
– You can choose what colors you’d like for your rainbow.
• Rita washes her hands and then looks at you and says “How do I dry my hands
off?”
– “You don’t like it that your hands are wet and you’re not sure how to dry
them off.”
• Rita responds, “Can I use the blanket?”
– “You think the blanket might work. You can choose to use the blanket.”
• Dedra writes a word on the dry erase board and asks with a perplexed look “Did
I spell it right?”
– “You look confused. You’re not quite sure it’s right.”
• Dedra responds “I know. Is it right though?”
– “It’s important to you that you spell the word just right. In here, you can
spell words anyway you want to.”
• Debra says, “But is it right?”
– “You really want to get it right. Well let’s see if we can figure it out
together…”
Facilitating Esteem
• Empower children to struggle with new
challenges
• Help children learn to deal with frustration
– “You’re trying to put those two pieces
together…It’s frustrating when it doesn’t do
what you want…Now you’re trying a different
way…You figured it out! You feel proud.”
Facilitating esteem
• Do not praise or criticize the child’s play,
behaviors, art, etc.
– Negates internal locus of evaluation
– Negates permissiveness
Facilitating Esteem & Encouragement
•
Octavious: Builds a tall tower out of blocks and says: “Look at this. Isn’t it
amazing?”
– You worked hard and you’re proud of your work.
•
Octavious: “Yeah. But what do you think of my tower?”
– You want to know what I think of your tower, but what matters is how you
feel about your tower.”
•
Octavious: Walks over to the chalkboard and says: “I am proud of my tower. I
know how to do multiplication.”
•
•
You’re proud of your tower and you’re proud of your math skills.
Octavious: Multiplies the numbers 20 times 20 and writes 400 on the board.
He says, “Look at this!!”
– You know how to do multiplication with big numbers and you’re excited
about it.
Limit Setting
• Protect child, therapist, or materials
• Helps child feel secure
• Promotes therapist acceptance of child
• Facilitates decision-making, self-
responsibility, and self-control
ACT Model of Limit Setting
• Acknowledge the feeling, want, desire. “You really
want to paint the wall.”
• Communicate the limit. “The wall is not for painting”
• Target acceptable alternative. “You can choose to paint
the paper, or you can choose to paint on the popsicle
sticks.
• If you choose to paint on the wall, you choose not to
play with the paint anymore today (Child paints on the
wall).
• I see you have chosen not to paint today. You can
choose to put the paint brush on the easel or you can
choose to put the brush on the shelf.
Limit Setting
• Jess: Picks up a dart gun and aims at you.
– Looks like you’d like to shoot me with that gun, but people are not for
shooting. You can choose to shoot the wall or you can choose to shoot
the pillow.
– You’d really like to shoot me with that gun, but…
– It you choose to shoot the gun you choose not to play with it anymore.
– I see you’ve chosen not to play with the gun. You can choose to put it
on the table or you can choose to give it to me.
• Ashley: “What would happen if I pulled the head off this doll?”
• Octavious: “I don’t have any cars like this at my house. Can I take this one?
I’ll bring it back next week.”
Questions
• Do not ask questions
• Be careful how you respond to
questions
• Listen empathically and respond to
the intention of the question
Responding to Questions
• “What is this?”
– “You’re trying to figure out what that is.”
• “Is this a real knife?”
– “You’re surprised to find that in here.”
• “How much time is left?”
– “I’ll let you know when we have 5 minutes left.”
• “Why do you talk like that?”
– “You think I talk funny.”
– “That’s just the way I pay attention to you.”
Strength-based Assessment
Strategy
• How do we know if our intervention
was effective?
– First, we identify what it is that we wish to
accomplish.
– Second, we find a way to determine if our
goals are being met.
Strength-based Accountability Strategy
• School success behaviors
– Self-control (emotional regulation, attention
control, impulse control)
– Self-efficacy (self-esteem, confidence)
– Social skills (sharing, taking turns, reading
social/emotional cues, perspective-taking)
(Arnold, Kupersmidt, Voegler-Lee, & Marshall, 2012; Brody, Flor, & Gibson, 1999; Jimerson, Egeland, Sroufe, &
Carlson, 2000; McLelland, Morrison, & Holmes, 2000; Raver & Zigler, 1997; Vidal, Rodeiro, Emery, & Bell, 2012;
Vitaro, Laroque, Janosz, & Tremblay, 2001; Von Suchodoletz A, Gestsdottir S, Ragnarsdottir H, et al., 2013)
Self-control
Self-efficacy
Social skills
•
•
•
•
•
• Helping someone
• Not giving up
• Solving a
problem
• Making a good
choice
• Creating
something
• Having fun
•
•
•
•
Taking turns
Sharing
Listening
Not giving up
Solving a
problem
Taking turns
Sharing
Apologizing
Helping
someone
• Listening to
others
• Complimenting
Strength-based, specific, and concrete behaviors
Integrate
because…
Techniques
include…
Assess
behavior
change
•
•
•
•
Evidence-based
Developmentally appropriate
Integration of explicit and implicit knowledge
Promotes school success skills
• Reflection, Facilitating Esteem, Facilitating
Decision-making, Limit Setting
• Self-control
• Self-efficacy
• Social skills
Questions? Comments?
Email [email protected]