Play Therapy

What is play therapy, and how do I do it?

If your child is on THE SPECTRUM or delayed in other ways, you’ve probably heard of “play therapy” by now.  Play therapy became popular in the 80s and 90s as professionals found out that getting down on the carpet with their autistic-type 2yr olds, and engaging them, actually made progress.  You’d think this would be obvious, but it wasn’t something that the professional community had necessarily thought of before—at least, not given at regular doses like “therapy.”  Before that, professionals were… well, professional.  They sat in chairs and had nice offices, but they administered tests, tried verbal exercises, and had children do activities mostly in chairs and desks.  Not exactly the comfort and freedom a child is used to.

Early Intervention is essentially “play therapy,” often mixed with speech therapy.  A trained special ed person comes to your house and plays with your little guy for about an hour.  She has a bag of toys with her and knows what’s she’s doing, but it is essentially play to engage your child with his or her weaknesses right where s/he’s most comfortable… on the living room carpet. Genius, right!

Well, the good news is you can do play therapy yourself too.  If you suspect your child is having developmental problems, if you know they do, or if they don’t but you’re just looking for some more educational time with them, play therapy is a great option.

For the bible on the subject, check out Stanley Greenspan’s book (http://www.amazon.com/Engaging-Autism-Floortime-Approach-Communicate/dp/0738210943/ref=sr_1_1?ie=UTF8&s=books&qid=1250945781&sr=1-1 ).   But if you don’t have time for that kind of thing, here’s basically what you need to do. (For ages 0-5).

1) Pick a space and time to do it.  mostly for you so you’ll stick with it, but also because the routine will minister to your child if they are hostile to the idea at first.  Most kids love the one-on-one time, but some don’t!   Make sure it’s a nice comfortable place with space to play.  Also make sure it’s not a naturally grumpy time for your child.

2) Set aside some special toys for the time.  You don’t have to spend a fortune at Toys R Us, but do consider getting some things that will make the playtime special and familiar.   And imaginative since that is usually an area most playtime kids have trouble with.  Sometimes this means just some props that you think of using a dozen different ways.  sometimes this is a favorite toy that a child will love going back to (i.e. a little Bob the Builder set or a Dora set).   There is merit in some of those toy companies like Imaginarium that make educational toys for kids, but use your own judgment.  (Try not to pick anything complicated or messy, which will discourage either you or your child from wanting to do it again!)

Also, check out a book like Jane Oberlander’s “Slow and Steady, Get Me Ready” (http://www.amazon.com/Slow-Steady-Get-Me-Ready/dp/159160236X/ref=sr_1_1?ie=UTF8&s=books&qid=1250945678&sr=8-1 ) for different activities you can do with ordinary household items.  You can incorporate a couple of these into your routine and change them out as necessary.

3)  Start with about 10 minutes for a reluctant child and work up to about an hour.  Start a couple times per week (i.e. MWF) and work up to every day (or even twice a day) depending on the severity of your child’s diagnosis.  Think of it like little doses of preschool.

4)  Ok, just start playing with your child.  Bring out one toy and set them in front of it, to see what they’ll do.  This is child-guided play where you facilitate.  Don’t jump in with your whole script and ideas.  You’re “peering” here.  And you’re building off what your child does.

It helps to have some goals in mind before you start, so know whether your focus is going to be physical, emotional/social, imaginative, language, memory, etc.  Your child may have a combination of goals, but try to target no more than two in a session.  When your child gets frustrated with a toy or can’t use it, then try another.  Don’t go through your props like you’re trying to please the child’s whims, but don’t exasperate them either.  You’re going to eventually spend time with everything you’ve got, so do some stretching.

5)  Play therapy is especially good for children with social, emotional, attention, and empathy problems.  They may not recognize or want you there in their space, and that’s fine.  that’s part of the therapy.  What you want to do is engage them, though, especially if they are autism spectrum.  If they jump their little horse up and down, you jump yours up and down near them.  If they get stuck spinning wheels, you crash your little car into them (gently) saying Vroom vroom!  Try to get them out of their world and into yours.  If they’re verbal but hostile to you, aim for the gentle but stubborn approach.

6) Use the toys vicariously, to get them to verbalize their experience.  If they don’t talk, that might be one of your goals: to get them to “talk” with their pieces. I have some ways to play with toys if your child is having trouble with language or imagination in other posts.  This is the first level of play therapy.

The second level is if your child is already verbal.  You want to use their toys as “counselors” or “mouthpieces.”  Don’t talk to them directly, use your piece.  Get them to talk back with their piece.  Kids will tell you all kinds of things if you let them talk through their pieces, about all kinds of things that upset them.  You can also teach all kinds of things through your pieces that they wouldn’t listen to you, their mom, about.  Now the playtime isn’t a teaching time, it’s an undersatnding time.  But a good therapist DOES use their “mouthpieces” therapeutically, say to discuss the toilet or a source of a bad dream, etc.  Use your imagination.

“Mommy, I’m BORED!”

There is probably no other complaint that can get a mom so upset.  Especially during summertime.  When it seems like everything is already down and dumpy, this comment can be the one that shoots Mom through the roof.  Even if it isn’t actually SAID, the one year old toddler has a way of making this known.  It can be SOOO frustrating!

Here’s the good news: you don’t have to do anything about it.  Lots has been written on boredom and how boredom is the source of creativity: if you get bored with life, you look for something to do.  So the application goes: if your child is bored with what they have, they need to look for a new way to use it.  But most kids under three have a limited imagination (especially if they are special needs), so it can be hard to wait through the tantrum or trouble a bored little kid gets into when they don’t know how to use what they’ve got.  Kids over three have great imaginations, but it can be hard to get them to want to use it.

Still, if I could impart one lesson to a new stay at home mom, it would be: don’t give into to the Boredom Complaint.  I used to all the time, and I’d go play with my child.  And it made him more dependent on me than ever.  I used to think he’d never use his imagination if I didn’t jump in, but I found out that my jumping in actually stalled him.  I think he was four or five years old before he’d really just play.

Now that doesn’t mean parents should never play with their children.  I totally believe they should, and my husband and I have some playtime with our kids every day, even if it’s just a botched game of UNO.  When my first was smaller, I used to use play therapy with him for his special needs.  That was extremely effective.  And he had Early Intervention too, which was also play therapy.  However, giving into the Boredom Complaint is not play therapy.  It’s manipulation… you’re trying to get your child to settle down and be happy instead of taking the stereo apart (if he’s a boy) or whining around your leg all day (if she’s a girl), and so you give in.  I know lots of people who swear that their girls in particular won’t DO anything.  They have to play with them!  What else could they do?

Well, a young child has to be trained to play of course.  They’re not six year olds who are enthralled with their lego castles yet.  (YET!)   As irony goes, your child won’t really get into settled down playing until they’re school age and not allowed to play all day anymore =)  But that still doesn’t mean you should be playing with your little guy all day… park trips, play time, cooking time, game time, etc.  If you are playing with your child all day except for when they nap or watch TV, then you are eventually going to end up with one big TV watcher!  I’m not kidding!  You have to find a way to HANG OUT with your child without playing with them.  Some children are persistent and even more moms are cave-in’s.  but your life will be SO much better if you do.

This is particularly difficult with your first child because it’s just you and him/her.  You look at each other all day and you’re tuned into each other’s emotions, schedule, etc.  It’s like you overlap in some ways.  Moreover, a baby needs 24/7 care, so it’s difficult to know how or when you should start leaving your “baby” alone.  At one, do you suddenly dissociate?  No, that’s not what I’m saying.

What I’m saying is, my later children are better adjusted than my earlier ones because they grew up not being focused on.  They were paid attention to a lot, but not focused on. There’s a huge difference. My little two year old (fourth child) still mostly shadows me all day.  But that’s her choice.  She has three other siblings to play with, so if she chooses to follow me around, then that’s her problem not mine.  I talk with her and sometimes share things with her or make them into an interesting activity for her, but I do it when it’s right for ME.  I don’t do it because she’s demanding it.  And if she’s in my way too much, I send her away.  This might hurt her feelings at first and then she suddenly realizes that she’d LIKE to play lego castles with her brother.  In personality, she’s a lot like her cousin who also shadows her mom and grandmom.  But the difference is that they feel bound to their little girl like she’s sucking the life out of them.  They feel obligated to “play” with her, to “educate” her, and make her happy, whereas I feel free to do the things I’m doing (most of the time   The main difference is in attitude: my little girl and I are HANGING OUT.  I love her and accept her.  That’s what families do.

So that’s my best piece of advice for mom and her two year old.  Hang out, but don’t focus.  This is difficult, but if you can pretend that you have other children around and a life to live while you’re shuttling just two year old Junior around, then do it.  Make calls, go to the mall (your favorite stores), and eat at the cafe you’d like.  Go to the playground if you want, but don’t feel obligated to suit your whole schedule around Junior.  Just make sure it’s Junior-friendly (i.e. no china shopping).  When you finally do have baby number 2, it will be the healthiest thing that’s happened to all of you.  But if you don’t plan on having baby number 2 until your first child is 3, 4, or 5 yrs old, you’d better start shifting into HANGOUT mode now.  I’m telling you: this is the number one thing that will change your stay at home experience =)

NOTE: for older kids, when they say “I’m Bored” you have three choices; either take away all their toys except for one ball.  Or throw them outside, even if it’s hot or drizzling.  Or make them work on a workbook or the laundry.  Any of these three options will get their imaginations fired up again in no time.

Self Esteem

Ok, I have a confession to make.  For my first two sons, I fell into the self-esteem trap of parenting.  You know, the “you can’t praise too much” trap?  Or sometimes it is said, “Make sure you give 10 good remarks for every 1 negative one.”  I really thought the more I heaped on praise, the better my children would feel about themselves.  Or at least I thought, if I avoided a lot of corrections, they would.

Turns out, I was wrong.  Like most moms, I sheltered my firstborn and he is now the most bitter and grumpy of my children.  Actually, he’s not too bad but in comparison to my third and fourth children, there’s no comparison to be made.  They are always happy, and my first is always needing a pick me up.  My second born is not too much better although he has a melancholy temperament (and always has) so I try not to take his sadness too seriously.

Nowhere can this be seen more clearly than in my typical homeschooling routine.  I have just started homeschooling in the last two years, and my kids follow a predictable line up: my firstborn starts off well but usually gets grumpy and frustrated with work, my second born is not totally happy but is very excited when he gets to do something “bigger” that his older brother gets to do (i.e. write a sentence!).  My third, who is only four and not kindergarten age yet, happily begs to work throughout the day.  And my fourth is too happy to care whether she gets a turn to work or not.   HA!

Some of this is surely typical of birth order and homeschool in general.  It’s hard to pioneer, it’s easier to follow.  And things become more fun with time.  But I am also sure that it is more than a homeschooling phenomenon… it’s kind of the same in every area of life.  Part of this is, I believe, due to the self esteem problem and the motivation style differences in my children.

For my firstborn, my husband and I were the typical parents cooing over the baby and over-obsessing about his developmental milestones.  He had some speech problems, so that made us all the more myopic.  We taught him and tutored him, we played games, we took him to specialists, he went to preschool etc.  And he had lots and lots of attention and praise.  Now at age 6.5, however, he is mainly externally motivated.  He’s motivated by praise and attention, but he has a hard time being happy when he doesn’t have it.  ANd like any child, the more they have, the more they want.  So school is difficult not because he doesn’t have enough character to stick with it–he does.  But it isn’t a joy to him, and that’s the hard thing.  Every parent wants their child to ENJOY learning, to be a reader, to get enthralled with some subject and just take off.  But he isn’t intrinsically motivated… yet.  He doesn’t see the thrill in making up a story, coloring a picture, or working on a project.  He just wants to get it done and then it’s over.  He likes learning of course, because he likes to be smarter than everyone else.  I think it makes him feel good to know things (as real self esteem should!).  But he doesn’t like or embrace the path to getting there.  It’s a battle.

In fact everything in his life is like that… if it’s not being monitored, it falls apart.  Very conditional, externally motivated ethics.  My second born, whom we did not lavish attention on, is slightly better adjusted.  But because he too had some special needs as a preschooler (sensory issues), he is also very hard to praise.  He has pretty good intrinsic motivation actually, and loves to get into science, art, or English.  But when I try to make him feel better about himself, it never works. I  can praise and praise.  I can encourage and encourage, and it doesn’t seem to make a difference. At 5.5yrs, he has a particularly salient perfectionism problem, and it is hard to get him to be happy with what he does.  It was like that when he was two and struggling with physical milestones, and all the praise in the world from me did not seem to convince him in his inner thoughts.  He’s mildly unconfident that what he does is good enough.

Now we come to my third and fourth children who, while they are far from perfect, are much more functional.  At least in the self-esteem department. I’ve never made an effort to praise them over and above—in fact, I’ve never worried about it—and they’re healthier!  They don’t seem hung up like their counterparts.  And I am sure letting the self-esteem education is part of it.  I’ve learned that the self-esteem really has to come from within.  It can’t be GIVEN or forced by an external party.  And in order for teh self-esteem to come from within, it has to be related to things the child can do for themselves.  So the more my children can do for themselves independently, the happier they are about it and the more intrinsically motivated they are to do it.  If I am happy about it too much, then I usurp their own happiness about it.  If I motivate it too much, then I usurp their motivation to do it.  There is a certain distance or disattachment that is important to healthy self esteem development.

That doesn’t mean I can be neglectful.  Being a passive and aloof parent will not yield a child who feels loved and praised.   But there is a certain KIND of distance which is very important to give a child, which I apparently did not give to my firstborn.  I tried to give it to my second born more, but he was hung up in a stage where he felt inept, and that went counteracted fora  long time.  So the kids have to experience victory for themselves, and they have to even initiate these victorious things.  The problem with my firsborn is that he doesn’t initiate things for himself—I have to be the initiator—so he can’t feel as happy about it.  That is one cycle of external motivation that is hard to break.  The areas where I don’t have any input (i.e. his lego building) tends to be the areas where he really excells and has his own fun.   ANd the more I push him to learn, even though he resents it at first, eventually becomes points of victory for him too because he gets more competence as he learns.

So it’s a tricky thing, but I just wanted to pass on the small bits of wisdom I’ve so far learned the hard way =)

Accidents (Wet Pants)

Do you have a bedwetter?  I have a little four year old who has had trouble mastering the fineries of toilet training.  Not a lot of trouble, but just enough that when I drop him off in a kids class, I am wondering whether he’ll be embarrassed that no other kids in there need spare shorts and underwear in their cubby.

He’s got a couple problems.  One, he still thinks he’s a victim of his pee pee =)  I’m not sure if he realizes that he controls his own muscles, but at least he talks like he’s not sure about that.  “It just came out” he’ll say.  So while he has good bladder control (he only needs to go to the bathroom about six times a day), he sometimes doesn’t make it to the bowl.  He has a lot of those accidents where he’s standing in front of the toilet but the pee pee came before he could aim.

He still also wets the bed.  Not a lot, but about once a week or a couple times a month.  Sometimes he has just some “off” days where he has a couple accidents in a row and then he’ll go two weeks without one.  Having helped a different child of mine through sensory processing disorder, I chalk this up to the brain’s differences each day.  I never realized how much just one day can make things “on” or “off” for a preschooler.  So I understand that to be normal for a still-developing child.

That said, it still is frustrating!  Who likes cleaning carpets and sheets all the time?  Who likes walking into their child’s room with that familiar but pungent smell of urine in the morning?  Worse still, my four year old is embarrassed!  He’s not so self-consciuos as a first grader would be, but he still HATES wetting himself.  Or getting a little bit of stool in his pants.

So here’s some things we’ve adopted that have helped a little bit.

1) Make sure your carseat is water resistant and easy to take off.  (We’ve been using the Graco booster)

2)  Make sure the child’s mattress is waterproofed.  The easiest thing to get is one of those $5 plastic mattress protectors at Walmart.  The plastic is soft enough that the kids don’t mind sleeping over it, and then you can just use a Clorox wipe post-accident.

3)  Keep the child out of socks.  Nothing makes cleaning up accidents worse than urinated socks.  Plus, it ends up making more places on your carpet you have to clean.  (Some people make the same argument for shorts and swear by sweatpants for accident-prone kids.)

4) Keep a sticker chart for awhile.  My little guy was having trouble recognizing if he was going through a problem season or having a good season.  So we kept a chart so he could see if he was doing well or not.

5)  Reward and punish as appropriate.  I don’t believe in punishing accidents as a rule since a lot of training is biological and takes practice.  But since the accidents mainly started a couple months after toilet training was successful, my husband and I now use some kind of positive and negative reinforcement at times.  I give my guy a jelly bean if he wakes up dry or has some kind of small victory like clean underwear for the day, and I take away his special Lightning McQueen blanket if he has an accident overnight (mainly because it’s so puffy that I hate washing it!).   You can use the excuse like “Lightning McQueen HATES getting wet.  He wants to stay away until he knows his paint will stay dry.”  He then has to wake up dry for 14 days in a row to get it back.   If he goes 14 days without a daytime accident, I let him go to a special kids club on Wednesday nights that my older boys go to.  (Mainly because the teachers there aren’t equipped to deal with toileting problems).

6)  Probably doesn’t need to be said but, baths every day.  A new toilet trainer or accident-prone child really ought to have a bath every day until they have a strong record of handling their own bums in private.  Also teach washing hands after EVERY trip to the toilet.  I used to make my boys only wash after a bowel movement (mainly because it seemed like they were always peeing), but I have learned with my third boy that their hands rest everywhere when they go to the toilet… like they hold onto the bowl to balance while they get their pants back on, or the sink.  They might inspect their underwear to see if it’s dry but their might be a small stool mark in there from not wiping all the way, etc etc.  Plus, it’s good practice for being in public when they should wash every time anyway.

Spend a good amount of time teaching good washing habits and you’ll have a lot less worry in your life. (NOTE: it’s perfectly normal for little kids to wash too long, use too much water, too much soap, etc.  Don’t stress it until about a year later.)   Make sure they can wash without your help or it will be too annoying.

Oppositional Defiant Disorder (ODD)

With the exception of branding our preschool boys autistic, nothing makes me madder than a diagnosis of Oppositional Defiant Disorder.  This is one of those retroactive “syndromes” that describes a child’s problem rather than lists a cause.  Getting a diagnosis does little more than relieve you that a professional thinks your child is as bad as YOU think s/he is.

I don’t say this because ODD isn’t real.  It is real.  I have seen the videos where clinical psychologists interview bunches of young children and diagnose some of them with this disorder.  The children are generally younger than you’d think (i.e. 4, 5, 6), violent, swearing, and have a fascination with things that they shouldn’t.  They are precocious, smart-aleck, psychologically astute.   They generally cannot stay seated in the psychologist’s chair, they may spit or verbally attack the professional, and they often make physical motions or get too close for comfort with their caretaker (like getting in their face, literally).

So it’s real.

That said, it’s an awful diagnosis—not worth getting, if you’re wondering.  Now i”m not talking about older children, like teens adopted out of the foster care system, etc.  I am talking about your unhandleable preschooler or kindergartner.  Now regular kids of this age can stretch you to your limits, so be careful how sensitive you are to this!  ODD is an extreme form of disobedient repertoire, and one that an overtaxed parent or teacher might not understand.  But if your child is suspected to have ODD, remember that for the most part, ODD at a young age is something that is created, not there at birth.  Now you may very well remember your baby being difficult from birth!  I am not saying that they weren’t a grumpy baby, or a colicky one, or hostile to affection, etc.  But children do come out of the womb grumpy.  They don’t come out ODD.

A really great book for those experiencing mild ODD with their young child is The Pampered Child Syndrome by Maggie Mamen.  http://www.amazon.com/Pampered-Child-Syndrome-Recognize-Professionals/dp/1843104075/ref=sr_1_1?ie=UTF8&s=books&qid=1250600538&sr=8-1 .  This book outlines a lot of ODD behavior but without the label and stigma.    Basically what it comes down to is that a permissive parenting style (mixed with your child’s unique temperament) can create a pampered, bratty child who is characterized by a lack of response to authority—the same major criterion of ODD.  We’re not just talking about the bratty children on Jo Frost’s Supernanny show… these children mainly suffer from a lack of childtraining.  But we’re talking about the next level of difficulty… children who actually don’t seem to recognize authority for what it is.  An ODD or ODD-leaning cihld is not very different from an autistic or Asberger’s child in that they have to be taught to recognize the context of structure, authority, obedience, etc.  They won’t pick it up on their own.  Although here is the good part—they are ABLE to pick it up, it is just that they choose not to.

So that is where you, as the parent, come in.  Your job is to take back the job that was stolen from you.  If your child is 6 or under, you’re lucky because it can be done.  You can use small child behavior modification  tactics that will help a lot.  (Get a season of Supernanny on DVD anyway, just for tips and impartation).  But the main thing you need to do is not enforce time-outs per se, or adopt some parenting trick.  What you need to do is examine yourself.  Examine your sense of boundaries and consider if you have codependent attitudes.  While a spouse might withstand codepedency, a child relationship will not.  Consider why it is hard for you to say no, disappoint someone, let someone not be rescued.  Consider if and how much you draw life from making others happy, or if you overesteem your own relationships in general (i.e. Do you idolize being a mother, wife, etc?).  If any of these kinds of characteristics typify you, as they do in some degree for all mothers, then seek help for yourself first.  Otherwise it will break your heart to do what you need to, in order to rescue your ODD child.

The main problem with the ODD child is the invisible dynamics in the household.  It is the subtext, the unspoken.  This atmosphere is mainly made up by your feelings and beliefs about yourself as a person and parent.  They have to change in order for your child to change.  That is why the kids on the Supernanny show mouth off to their parents but they never mouth off to Jo.  It is because of the spirit of conviction and authority that comes with her.  This is what is right, and what you need to develop.  If you can’t stand that idea, or you think that it’s wrong to be an authoritative (not authoritarian) parent, then this is where Step One begins.   Step One is over when you realize that the results you’re getting in your ODD child is the logical extension of your emotions and beliefs.  It’s not random and you’re not a victim. You have a lot of power in this relationship, power to influence your child for good.  And you’re going to have to use it!

When you finally finish Step One, you’re ready to start boundaries in your home.  You’re ready to stop the welfare state—where you do all the work and the kids just receive.  The sense of entitlement your ODD child has is partially what’s making him or her bitter at authority.  They have to get rid of that entitlement feeling in order to respect authority, limits, work, or whatever thing they hate.  When the bitterness is out, a lot of the anger will go with it.  And so will any depression or anxiety they likely also have.