My Therapist's Journey: Play Therapy

The second biggest pillar of my early training was play therapy. I probably did more play therapy than anything else during grad school because I had a part time job placed in an elementary school treating about 15 children per week.

Children taught me a lot about how to bring spontaneity and playfulness into my work. Children will not put up with a neutral, distant person and will tell you whether you are doing right by them, whether you like it or not. If you listen, they will teach you how to be the therapist they need, but you still need to play and experiment for them to know "yes, more" or "no."

When I was thrown into play therapy, I never really received any clear instruction on how to be therapeutic. I even took a semester-long class on child therapy but didn't learn a thing about technique, just a bunch of theory. Now, it is true that some of the developmental and dynamic theories were informative and I found that children's imaginative play often paralleled real-life themes. For example, one five-year-old only watched Lion King up to the point of the father's death and then rewound the tape over and over again. Other children play out generalized themes of powerlessness, fear, family stress, social stress, anger or sadness. But, this work was plodding and it was often difficult to know how to make this play helpful in the real world. Furthermore, many young children quickly grow out of pretend play beginning around age 7 and move into board games and other rule bound games.

It was through hours of playing Uno and Sorry and Trouble that I began to understand that children at this stage were practicing a variety of skills: turn-taking, following the rules, reciprocity, fairness, impulse control, controlled aggression, good sportsmanship, decision making, frustration tolerance, planning, etc. I really began to understand moment to moment activities in terms of what skills or neuro-cognitive functions were being expressed and exercised.

I also had the amazing fortune of learning Ross Greene's Collaborative Problem Solving Approach early on and co-led parenting groups with him in an outcome study comparing his approach to Russell Barkeley's Defiant Child approach, which is a classic behavior management approach. I was beginning to see behavior as being the shaped by external reinforcements (as highlighted in behavior management), neurocognitive drives and deficits (Ross Greene), and internal psychic and relational drives (psychodynamic).

I was becoming more and more interested in diving deep into the moment-to-moment world of play and overlaying these paradigms onto the immediate behaviors and experiences. I started to care more about how things are being said and done versus what was being said or done. In fact, I rarely ever asked children how they were doing or bothered with helping them "open up." Instead, I just played as hard as I could. I tried to really imagine all of the imaginary actions happening between characters. I competed in board games with gusto. I began to figure out what the issues were as they emerged in moment to moment play and tried to figure out ways to correct them without leaving the play.

This obsession with the moment to moment process has carried with me throughout my work and remains a core aspect of how I work and what makes me effective. I listen and observe on so many levels at once: what's being said or done, how, when, why now, how it's connected to history or to other relationships, what's the deficit or the struggle, what's the yearning or aspiration, what's the hurt and pain?

In future posts, I'll give a nod to cognitive-behavioral approaches and then spend a lot more time on modern relational approaches as applied to individual and family work.

The Truth about Trauma Work

I was working with a couple terrorized by demons of severe trauma experienced as children, re-inflicted on each other. They lashed out at each other trying to cause as much pain on the other as they felt themselves. 

And I dove in head first with barely a safety line in tow. 

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My Therapist's Journey Part 1: Insight.

I've learned so many different types of therapies over the past 20 years and continue to take from everything I’ve ever learned. In a series of posts, I'm going to share what I've personally learned about therapy and becoming a therapist. I hope these posts help future therapists embrace their own journeys and help patients feel more informed and empowered to seek good and smart therapists rather than good and smart therapies that fit their needs in their current moment. 

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More on Clinical Strategies for Nurturing Knownness

More and more, I’m realizing that the essence of the work I do is creating an inviting space between people to be vulnerable and explore their inner worlds and those of other people with compassionate curiosity. I do this in my individual work and in my family work. I think this co-created space is the fertile ground in which psychological growth occurs. Here’s an example of how a young boy, his mother, and I created this space together. When done well, this strategy invites amazing insights from children that you would never see coming otherwise.

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Ode to A Depressed Person

I know someone who always feels like ending her life. I told her that I admired the way she lived, which is a ridiculous thing to say. Why would anyone admire someone who is always at baseline suicidal? I tried to unpack what I meant by it and this is what came out:

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My Patient's Lovely Description of Our Therapy

It's like you hold up a mirror and I really don’t want to look into it because I think I am so ugly, but deep inside I wish I were cute and pretty (she tears up). But, you keep holding up the mirror and show me that I just have some dirt on my face and you help me brush it off. Then I begin to realize that maybe I’m not so ugly...

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Testament to the courage of trauma work

Everyday I'm grateful for the chance to share my patients' journeys to overcoming so much and claiming their lives as their own, free from history and fear. This time the work has been put down on paper in the form of a memoir that documents one person's entire history of abuse and recovery. He was so afraid and ashamed to share it, yet it was one of the most powerful acts of healing he could have ever experienced, and it has touched the life of others in a way that he could never have imagined. Talk about turning tragedy into triumph. 

The last part of the book includes scenes from our sessions together, which is always hard, like listening to and disliking your voice when you hear it played back. But, I take a step back from this self-consciousness and stand in amazement and pride at what we accomplished in the journey of our work together. 

I feel it would be too self-promotional to tell everyone to go out and buy the book (like saying, "Look how great I am," which I'm clearly not), so suffice it to say that I think it could be an inspirational read for anyone who has lost hope or doesn't believe that things can ever get better.

I also have to qualify with a trigger warning: the first few chapters go into detail about childhood abuse and can be hard to get through. It was for me at least. 

Today's Touching Family Moment

Today a man,
who just months ago
was unsure
whether he wanted family therapy
(at least with me)
then only wanted to work on problem solving,
then only wanted to intellectualize,

finally cried
about missing his father,
grieved the imminent loss of his favorite uncle,
and shared how he suffers
a desperate longing
to connect
with his teen-age son
(who can't make sessions
because of other commitments).

And his wife and daughter
leaned into his pain
with tears in their eyes,
not talking,
not problem solving,
only conveying
love
and gratitude.

And I too honestly
felt moved
like listening to Adele
or singing Karaoke :-) 

And I reassured the father
that this new man
will draw his son
inexorably
like love
is wont to do.

 

Being a Good Listener, the Key to Being a Good Therapist

Wow, I just watched a video by The School of Life that captures 80% of what I have taken so long to learn in my journey to become what I feel is a good therapist: a good listener. I've never heard anyone else articulate the essential ingredients of good listening so concisely and so in line with the things I've had to learn on my own through hundreds of hours of practice. I'm embedding the video at the bottom.

Here is a summary of the key points: 

  1. Encourage people to elaborate their point, instead of responding with your own story, because most people don't know quite what they are trying to say and need to talk it out to pinpoint it; and keep the speaker's history in mind as you listen to new information and connect it all, so they make new insights and feel deeply heard. 
  2. Urge clarification about why someone feels a certain way to help them understand their own life themes and values and definitely don't move to reassurance and advice giving too quickly.
  3. Don't moralize and judge; instead, respond with small sounds of sympathy and reassurance. Realize that we are all weak and vulnerable in some way. Warm to vulnerability, instead of rejecting it.
  4. Separate disagreement with hostility. Invite or at least allow for disagreement in the relationship to show that people don't always have to agree to remain in relationship with each other. (This one isn't as often used as a therapist but sometimes it does happen). 

In my thinking, I've been summarizing good listening as Compassionate Curiosity, a nonjudgmental empathic desire to keep learning more and more about a person that can only happen through explicit intention, bracketing of judgement and willingness to identify the hidden virtues and values behind embarrassing and shameful emotions that block true exploration. So very similar!