David A. Crenshaw, Ph.D., ABPP, RPT-S Clinical Director, Children’s Home of Poughkeepsie Faculty Associate, Johns Hopkins University

 Wittgenstein: “You can’t enter any world for which you don’t have a language.”  “You can’t build loving relationships without a language for affection” (David Whyte, 2008,

The Three Marriages,

New York: Riverhead)  You can’t build therapeutic relationships without a language for healing. Distinction between healing and treating.

    ◦ ◦ ◦ ◦ ◦ ◦ ◦ Self-Calming Rituals Centering Stones “Sandy Bottom” (Siegel, Kabat-Zinn) Creating Safe Places Build with materials in the room Create in fantasy An internal space With Clay In Sand Make a collage Family Puppet Play

 ◦ ◦ ◦ ◦ Coping with Dissociation (Yvonne Dolan) Counting second hands on a watch Counting fingers Counting books with blue jackets Rule of 2/3rds (Kevin O’Connor)  ◦ ◦ ◦ Timing and Pacing Metaphor of Family Photo Album (Joyce Mills) Box of “unmentionables” “Garbage bag” (Beverly James)

 ◦ ◦ ◦ ◦ ◦ ◦ ◦ ◦ Affect Regulation Volcano Drawings (Eliana Gil) Storm Drawings (Rage or Terror Expression and Modulation) Angry Monster Fire-Breathing Dragon Raging Bull “Party Hats on Monsters” (Crenshaw, 2001) Projective Drawing and Storytelling: “Blow-Up Bernie” (Crenshaw, 2008a) “Downshifting”

 ◦ ◦ Play Strategies “Alligator goes Ballistic” “Passport Protected Coping Club”  ◦ ◦ ◦ Cognitive Strategies Problem solving and develop laminated “Menu of Best Coping Strategies” Problems solving and develop laminated “Menu of Best Coping Statements” Safety Plan

 ◦ ◦ ◦ Learning the Language of Feelings Feelings Map (Drewes) Heartfelt Feelings Strategies (HFS) Expressive Cards in the Heartfelt Feelings Coloring Card Strategies  ◦ ◦ ◦ Education about Specific Symptoms Flashbacks (voluntary vs. involuntary subjective experience—Jay Haley) Dissociation (when it is helpful—when it is not) Teach about Defenses (Metaphor of “Fawn in Gorilla Suit”)

        Role Playing Behavioral Rehearsal Social Skills Training Groups Empathy Training Exercises Recognizing Social Cues Reading Facial Expressions Starting and Maintaining Conversations (last 3 particularly valuable with Asperger’s and Non Verbal LD, but aggressive and traumatized child, highly anxious children as well) Importance of Humor

 ◦ ◦ ◦ ◦ ◦ ◦ ◦ Honoring Strengths and Validation Personal symbol of Unique Genius (David Whyte) Symbols representing Strengths or Redeeming Qualities “Badge of Ability” (Hardy & Laszloffy, 2005) Projective Drawing and Storytelling: “The Ballistic Stallion” and “The Wise Ole Owl” (Crenshaw, 2008a) “Mountain of Strengths” (Crenshaw, 2006) “Cumulative Strength List (Mordock) “Superheroes” (Larry Rubin)

  ◦ ◦ ◦ ◦ Reframing Suffering as Basis of Strength (Ben Furman) “Courage Tapes” Stories of Sports Heroes (Crenshaw & Barker, 2008) “Three Doors” (Door #1, Crenshaw) Shifting Identification from Aggressor to Empowering Helper Role (Kevin O’Connor) ◦ ◦ Developing Capacity for Gratitude “Coins in Fountain”-An exercise in appreciation (Crenshaw) “Giving Thanks”

 Directed Drawings ◦ ◦ ◦ ◦ ◦ ◦ “Inside/Outside” (Beverly James, 1989) “Color-Your-Life” (O’Connor, 1983) “Boat in Storm” (Oaklander, 1988) “Your Place” (Oaklander, 1988) “The Cave” (Crenshaw) “Serial Drawings” (John Allen, 1988)

 ◦ ◦ Projective Drawing and Storytelling “The Misunderstood Mouse” (Crenshaw, 2008a) “The Secret Life of Nicole” (Crenshaw, 2008a)  ◦ ◦ ◦ Clinical Use of Symbols Symbol Association Therapy Strategies (SATS-C) (Crenshaw, 2008a) Directed Symbol Work HFCCS (Relational Strategies)  ◦ Child Directed Play A Case Example: “Stitches are Stronger than Glue”

 ◦ Spontaneous Drawings Clinical Example: “The Dragon in the Well for 150 Years”  Creative Writing  Poetry  Music  Journal Writing

 Loss and Grief ◦ ◦ ◦ ◦ ◦ “The Magic Key” (Crenshaw, 2008a) “The Puppy in the Animal Shelter” (Crenshaw, 2008a) “The Bunny seeking her Mother” (Crenshaw, 2008a) HFCCS Relational Strategy (“Person who will be in your heart forever”) “Heart Symbol Strategies” (Crenshaw)

 “The Linking Object” (Crenshaw, 2008a) ◦ Based on psychoanalytic writing of Volkan (1983) ◦ Rationale: Traumatic grief that the child can’t access, detached or cut-off from feeling. This disconnection is causing problems in the child’s functioning and other less evocative strategies have been tried.

◦ This is an intervention (not a strategy) that should only be used under supervision or in close consultation with a colleague

 ◦ ◦ ◦ Projective Drawing and Storytelling Strategies “Fourteen going on Twenty” (Crenshaw, 2006) “Mike’s Version of Russian Roulette” (Crenshaw, 2008a) “Eli and Zuko in the Land of Endless Hope” (Crenshaw, 2006)  Project Approach with Adolescents (unsafe sex, dangerous driving, alcohol and drug abuse, eating disorders, self-mutilation, and suicidal spectrum behaviors)

 ◦ ◦ ◦ ◦ Projective Drawing and Storytelling “Jake the Boy who sit alone in the Cafeteria” (Crenshaw, 2008a) “The Pig who Didn’t Fit” (Crenshaw, 2008a) “Behind the Closed Door” (Crenshaw, 2008a) “The Fair Trial” (Crenshaw & Mordock, 2005b)  Soliciting Prideful Stories with Child and Family (Fiona True, Ackerman Institute for the Family)

     ◦ HFCCS (“Relational--Person who was once in your heart but no longer is”) “The Three Doors” (Door #2, Crenshaw, in press) Child-Directed Symbolic Play Clinical Use of Symbols (“The 140lb. Weight on my Back”) Projective Drawing and Storytelling “The Tree on the Hill” (Crenshaw, 2008a)

    “Hope can be Dangerous” (Walter Bonime, M.D. Senior Training Psychoanalyst) “Magic Stones” (Crenshaw, 2006) “The Three Doors” (Door #3, Crenshaw, in press) Scaling Techniques (Solution-Focused) “House of Hopes, Dreams, and Promises” (Crenshaw, 2008a)

      “Story of Jose and Pete on the Mountain” (Crenshaw, 2006) Countdown Album Talk Show Letter “One Last Conversation”

   “Doing” is the easy part (Crenshaw, 2006, 2008a) Conversations with Ken Hardy, Eliana Gil, and Garry Landreth “Being” is much harder. It takes a certain maturity and ripening as a therapist to appreciate the importance of “being” as well as to realize just how difficult it is to be fully present in the midst of a child or family’s raw pain (Crenshaw (ed.) 2008b