Effectively Blending Play Therapy Techniques with CBT: Helping

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Effectively Blending Play Therapy Techniques Effectively Blending Play Therapy Techniques with CBT: Helping Children Identify, Express & with CBT: Helping Children Identify, Express & Integrate Angry and Aggressive Feelings Integrate Angry and Aggressive Feelings 13 13 th th Annual Virginia APT Summer Workshop Annual Virginia APT Summer Workshop June 13, 2009 June 13, 2009 Athena A. Drewes, Athena A. Drewes, PsyD PsyD , MA, RPT , MA, RPT - - S S Astor Services for Children & Families Astor Services for Children & Families Poughkeepsie, NY Poughkeepsie, NY adrewes@hvc.rr.com adrewes@hvc.rr.com Neurobiology of Maladaptive Neurobiology of Maladaptive Aggression (James Blair et al 2005) Aggression (James Blair et al 2005) Reactive (RADI) and Proactive (PIP) Aggression Reactive (RADI) and Proactive (PIP) Aggression are supported by very different neuronal are supported by very different neuronal architectures architectures Work with animals identified a neural circuit that runs Work with animals identified a neural circuit that runs from the medial nucleus of the from the medial nucleus of the amygdala amygdala , to the medial , to the medial hypothalmus hypothalmus , and from there to the dorsal half of the , and from there to the dorsal half of the periaqueductal periaqueductal gray.

This circuitry ... more. less.

allows the expression gray. This circuitry allows the expression of reactive aggression in mammalian species, including of reactive aggression in mammalian species, including humans. humans. Athena A. Drewes, 2009 Athena A. Drewes, 2009 Neurobiology Continued Neurobiology Continued The circuitry can become dysfunctional. This can occur The circuitry can become dysfunctional. This can occur in four ways. in four ways. Not knowing right from wrong Not knowing right from wrong , , not making not making rational rational decisions decisions : adds other complexities that have to be : adds other complexities that have to be addressed separately. addressed separately. The first two potential ways relate to the basic neural The first two potential ways relate to the basic neural circuit that responds to threat and allows the expression circuit that responds to threat and allows the expression of reactive aggression (fear and frustration). of reactive aggression (fear and frustration). Athena A. Drewes, 2009 Athena A. Drewes, 2009 More Neurobiology More Neurobiology The third and fourth potential ways relate to regulatory systems The third and fourth potential ways relate to regulatory systems for this circuitry. The functioning of the medial and orbital for this circuitry. The functioning of the medial and orbital frontal systems involved in the regulation of the basic threat frontal systems involved in the regulation of the basic threat circuitry can be compromised. circuitry can be compromised. Impulsive aggression can be the result of excessive activation, Impulsive aggression can be the result of excessive activation, deficient restraint (self regulation) or both. deficient restraint (self regulation) or both. These deficiencies can arise out of genetic vulnerability These deficiencies can arise out of genetic vulnerability (endogenous) or abuse and trauma (exogenous) contingencies. (endogenous) or abuse and trauma (exogenous) contingencies. Dr. Hans Steiner, Stanford University School of Medicine, Center Dr. Hans Steiner, Stanford University School of Medicine, Center for Psychiatry and the Law, 2005. for Psychiatry and the Law, 2005. Athena A. Drewes, 2009 Athena A. Drewes, 2009 Play Therapy with Angry and Play Therapy with Angry and Aggressive (Traumatized) Children Aggressive (Traumatized) Children Treatment Treatment Rapport Building Rapport Building Setting a context for therapy Setting a context for therapy Safety and Trust issues Safety and Trust issues Speaking to the parents and Speaking to the parents and children about therapy children about therapy Athena A. Drewes, 2009 Athena A. Drewes, 2009 Directive vs. Non Directive vs. Non - - Directive Directive Directive Approach: The therapist takes responsibility Directive Approach: The therapist takes responsibility for guiding the therapy process and challenges the child for guiding the therapy process and challenges the child to address specific concerns. to address specific concerns. Nondirective Approach: Provides the child with ample Nondirective Approach: Provides the child with ample opportunity to direct his or her own therapy and opportunity to direct his or her own therapy and encourages insight and personality development encourages insight and personality development through interpretation of play and behavior. through interpretation of play and behavior. Integrated Approach: Respects traumatized children Integrated Approach: Respects traumatized children 9 9 s s competing drives for mastery and control versus competing drives for mastery and control versus suppressing and avoiding painful and suppressing and avoiding painful and conflictual conflictual material. material. Athena A. Drewes, 2009 Athena A. Drewes, 2009 Feeling Feeling - - Thought Thought - - Behavior Awareness Behavior Awareness To identify and understand the difference between To identify and understand the difference between a feeling state and a cognition a feeling state and a cognition To understand how feelings, thoughts and To understand how feelings, thoughts and behaviors interact with one another. behaviors interact with one another. To understand that feelings are not mutually To understand that feelings are not mutually exclusive of one another. exclusive of one another. Athena A. Drewes, 2009 Athena A. Drewes, 2009 What is under the Anger? What is under the Anger? Helping Children Understand Emotions in Helping Children Understand Emotions in Themselves Themselves Identifying Physical Manifestations of Identifying Physical Manifestations of Different Emotions Different Emotions Guided Imagery Exercise (Paula, 2006) Guided Imagery Exercise (Paula, 2006) Basket of Feelings Basket of Feelings Gingerbread Feelings Map Gingerbread Feelings Map Athena A. Drewes, 2009 Athena A. Drewes, 2009 A Simile from Angry/Feeling Words A Simile from Angry/Feeling Words Simile Simile 3 3 a comparison between two unlike objects a comparison between two unlike objects (e.g., anger is like a thunderstorm). (e.g., anger is like a thunderstorm). Regularly the words Regularly the words c c as as d d and and c c like like d d are used in are used in similes. similes. Examples: Examples: Silent as a guilty child Silent as a guilty child Excited as a wiggly puppy Excited as a wiggly puppy Sad like an unused toy Sad like an unused toy Athena Drewes 2006 Athena Drewes 2006 Create a Feelings Create a Feelings Cinquain Cinquain Cinquain Cinquain is a short poem consisting of five lines. The is a short poem consisting of five lines. The lines usually do not rhyme. lines usually do not rhyme. Create a Create a cinquain cinquain about anger. about anger. c c Anger Anger d d can be the title can be the title and the first line of the poem. and the first line of the poem. 1 1 st st line line 3 3 one noun (anger feeling) one noun (anger feeling) 2 2 nd nd line line 3 3 two adjectives describing the noun in line one two adjectives describing the noun in line one above. above. 3 3 rd rd line line 3 3 three words that express feeling. three words that express feeling. 4 4 th th line line 3 3 four related words that express a feeling, four related words that express a feeling, describe line one, and tie the poem together describe line one, and tie the poem together 5 5 th th line line 3 3 another word or synonym for the noun in line another word or synonym for the noun in line one one Copyright Dr. Athena A. Drewes, 2008. All rights reserved. Copyright Dr. Athena A. Drewes, 2008. All rights reserved. c c Anger Anger d d Cinquain Cinquain - - Example Example Anger Anger Upsetting, disturbing Upsetting, disturbing Poking, bumping, pushing Poking, bumping, pushing Not always a friend Not always a friend Hot Hot - - tempered tempered Copyright Dr. Athena A. Drewes, 2008. All rights reserved. Copyright Dr. Athena A. Drewes, 2008. All rights reserved. Draw a Road Map of Your Life Draw a Road Map of Your Life Show good places Show good places Bumpy spots Bumpy spots Barriers Barriers Make a map of where you have been Make a map of where you have been Where you want to go Where you want to go What What 9 9 s keeping you from getting there s keeping you from getting there What I need to get there What I need to get there Athena A. Drewes, 2009 Athena A. Drewes, 2009 Magic Wand Magic Wand Create magic wand. Create magic wand. What would you change if you could? What would you change if you could? What would you change about school? What would you change about school? What would you change about your friends? What would you change about your friends? What would you change about yourself? What would you change about yourself? How would your life be better with the change? How would your life be better with the change? Copyright Dr. Athena A. Drewes, 2008. All rights reserved. Copyright Dr. Athena A. Drewes, 2008. All rights reserved. Magic Magic Imagine that you have power to do anything you Imagine that you have power to do anything you want in this world want in this world If you were magic, where would you like to be? If you were magic, where would you like to be? Draw what you would do and where you would Draw what you would do and where you would be be Athena A. Drewes, 2009 Athena A. Drewes, 2009 Magic Powers Magic Powers If you could have any of the following, what would you If you could have any of the following, what would you like most to stop people from bothering you or hurting like most to stop people from bothering you or hurting you in some way? you in some way? Color in or mark the ones you would like. Color in or mark the ones you would like. If it is none of these, what would it be? Draw it in the If it is none of these, what would it be? Draw it in the empty box. empty box. Boxes: A fort, so they can Boxes: A fort, so they can 9 9 t reach you. Magic dust to t reach you. Magic dust to make them disappear. Your very own army. A coat of make them disappear. Your very own army. A coat of spikes. To be able to blow fire like a dragon. An invisible spikes. To be able to blow fire like a dragon. An invisible cloak. A magic sword. cloak. A magic sword. Athena A. Drewes, 2009 Athena A. Drewes, 2009 Safe Place Safe Place Imagine Safe Place Imagine Safe Place Zoom in and look around, feel, smell Zoom in and look around, feel, smell What is there What is there Name the place Name the place Visit it when upset or scared Visit it when upset or scared Practice, practice, practice Practice, practice, practice Athena A. Drewes, 2009 Athena A. Drewes, 2009 Part III: Behavioral Part III: Behavioral Dysregulation Dysregulation Emotional Management Skills for Behavioral Emotional Management Skills for Behavioral Distress: Distress: Time out Time out Leaving the stressful Leaving the stressful situation situation Athena A. Drewes, 2009 Athena A. Drewes, 2009 Stick Puppets Stick Puppets Use craft sticks and have child make one for Use craft sticks and have child make one for each member of the family. each member of the family. Use the stick puppets to role play situations with Use the stick puppets to role play situations with family members or classmates. family members or classmates. Use stick puppets to problem solve situations Use stick puppets to problem solve situations Athena A. Athena A. Drewes, 2009 Drewes, 2009

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