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Integrating Brief, Strength - based Therapy and Play ( A. K. A Play ! Play ! We Don ’ t Have All Day !”) Heather Thompson Assistant Professor of Counseling.

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Presentation on theme: "Integrating Brief, Strength - based Therapy and Play ( A. K. A Play ! Play ! We Don ’ t Have All Day !”) Heather Thompson Assistant Professor of Counseling."— Presentation transcript:

1 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

2 Integrating Brief and Play Therapy ResearchTheoryPractice Cont ext Practice Theory Research

3 Trauma Skills Self-concept Self-efficacy Mastery and competence SFBT and Play Therapy Practice & Theory Self-concept Feelings about self Behaviors and Choices Thoughts about self

4 Research Time Resources Space CBT & SFBT Social skills 5-10 hours group

5 Today ’ s Journey How is play compatible? Why integrate play? How to integrate play and brief therapy How to assess growth and development

6 Solution - focused brief therapy ( SFBT ) Non - directive play therapy ( NPT ) Focus on the present Build on strengths Help children experience positive behaviors Build self-efficacy Focus on the present Build on strengths Help children experience positive behaviors Build self-efficacy Compatib ility

7 Solution - focused brief therapy ( SFBT ) Non - directive play therapy ( NPT ) Establish and work toward goals Promote behavioral change Promote decision-making and self- responsibility Enhance frustration tolerance Facilitate emotional regulation & impulse control Facilitate understanding and expression of emotions, intentions, wants, desires Promote understanding of the connection between emotions, intentions, reactions, and behaviors Why Integrate Play?

8 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) http://www.youtube.com/watch?v=_4ovwAdxCs0

9 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

10 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 Why Integrate Play?

11 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 (Levy, 2008)

12 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 (Fosshage, 2004; Kay, 2009; Lyons-Ruth, 1999; Pally, 2005)

13 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 under- development of Mirror Neurons Mirror Neurons & Perspective - Taking (Fogerty, 2009 ; Iacoboni 2005; Rizzolati & Craighero 2004; Wolf et al. 2001)

14 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)

15 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)

16 Why Integrate Play Assess real-world application Freeze-frame

17 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

18 SFBT GoalsCorresponding SFBT Techniques 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 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”

19 NPT GoalsCorresponding NPT Techniques Conscious awareness of emotions, intentions, needs, etc. Draw on strengths & builds self-efficacy Build self-efficacy & enhance frustration tolerance Promote decision-making and build self- efficacy Facilitate emotional regulation and impulse control & promote decision- making and self-responsibility Reflecting feelings, prosocial behaviors, intentions, and meaning Reflecting success, exceptions, and positive changes Facilitating esteem and encouragement FEE Facilitating decision-making and self- responsibility FDR Limit setting LS

20 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 http://www.youtube.com/watch?v=JIMWOOlR_9g

21 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.”

22 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.

23 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.”

24 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.

25 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

26 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.

27 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…”

28 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

29 Facilitating esteem Do not praise or criticize the child’s play, behaviors, art, etc. – Negates internal locus of evaluation – Negates permissiveness

30 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.

31 Limit Setting Protect child, therapist, or materials Helps child feel secure Promotes therapist acceptance of child Facilitates decision-making, self- responsibility, and self-control

32 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.

33 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.”

34 Questions Do not ask questions Be careful how you respond to questions Listen empathically and respond to the intention of the question

35 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.”

36 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.

37 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)

38 Self-control Taking turns Sharing Listening Not giving up Solving a problem Self-efficacy Helping someone Not giving up Solving a problem Making a good choice Creating something Having fun Social skills Taking turns Sharing Apologizing Helping someone Listening to others Complimenting Strength-based, specific, and concrete behaviors

39 Evidence-based Developmentally appropriate Integration of explicit and implicit knowledge Promotes school success skills Integrate because… Reflection, Facilitating Esteem, Facilitating Decision-making, Limit Setting Techniques include… Self-control Self-efficacy Social skills Assess behavior change

40 Questions? Comments? Email ehthompson@wcu.edu


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