Practical Implementation Phase 1: History Taking is synonymous to an intake assessment. During this initial session, the clinician focuses on gathering information from caregivers about the client and his or her
presenting problem.
experienced distress,
including events of abuse, neglect, loss, or
transition. Through this process, RPT/Ss can identify target memories that are sources of distress for the child (Adler-Tapia & Settle, 2008).
Phase 2: Preparation orients a child and his or her family to EMDR (Adler-Tapia & Settle, 2008). The storybook Dark, Bad Day… Go Away! (Gomez, 2007) introduces EMDR to children with its simple storyline and colorful illustrations. Because of its uncomplicated explanation of EMDR, I usually request that guardians review this book during sessions. Equally useful is My EMDR Workbook (Adler-Tapia & Tapia, 2008), which gives concise explanations of each treatment phase. This resource helps clinicians track children’s progress through its interactive format and spaces for illustrations.
Phase 3: Assessment focuses on the selection of negative thoughts and their positive opposites for use with BLS, the creation of an imaginary container into which negative thoughts can be stored, and a safe place (positive imagery) which can provide relief to the child during and outside of session (Shapiro, 2018). RPT/Ss can identify target thoughts during this phase through artistic and hands-on interventions. For instance, children have positively responded to prompts asking them to draw or write their “yucky memories” onto note cards. Then, we have “locked” the cards in small plastic boxes, which serve as visual representations of their imaginary containers (cf. Beckley-Forest, 2015).
When children make negative references to target
memories… I quickly tap multiple BLSs to help children process these negative events
negative cognitions for children. I have printed these cognitions onto individual index cards and laminated them for reuse. One side contains the negative belief (e.g., “I am not safe”), and the opposite side provides its positive counterpart (e.g., “I am safe”). During assessment, I read each card aloud and direct children to keep the cards that match how they think or feel about yucky memories. Since some children may prefer nonverbal activities to convey their thoughts and emotions about these memories, I offer hands-on activities, such as artwork or sand tray as alternatives.
Another facet of the assessment phase is the evaluation of how distressed a child feels during his or her recollection. Directing children
10 | PLAYTHERAPY June 2019 |
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(VOC) will indicate the depth of children’s distress for the clinician. Simply scale (0 = no distress, 10 = the most distress the child can imagine). VOCs reflect how true the child believes the positive cognition to be when it is considered in the context of the traumatic memory, also on a sliding scale (1 = totally false, 7 = totally true). Because posttraumatic stress can manifest as physical pain, EMDR also emphasizes clients’ reports of physical discomfort. Children must be able to recognize an emotion and its physical location for a therapist to evaluate progress (Shapiro, 2018).
To gather these details in a fun and non-threatening way, I designed two colorful foam door hangers with stick-on numbers as measurement scales. I also created a “magic wand” to use as a pointer (a short plastic rod wrapped in colored tape and decorated with glitter and feathers). After giving children these materials, I read each negative cognition aloud from cards they preselected regarding the traumatic memory. I encourage children to use the wand to show which number denotes how seriously they believe the thought and how intensely they feel the emotion. Afterwards, I direct children to use the wand to show me where on their bodies they feel sadness, worry, or anger about the “yucky thoughts.” Due to its playful appeal, the wand has helped children more easily indicate physical symptoms.
Phase 4: Desensitization and Phase 5: Installation involve using BLS to process traumatic memories, to decrease negative beliefs about self, and to introduce their positive alternatives. Play therapists can children in BLS (Shapiro, 2018). Often, I explain to children that their plastic container will be “unlocked” during session and a yucky memory chosen as a sand tray prompt. I then present children with their note cards, door hangers, and magic wand. They use these resources to provide a baseline measurement for BLS effects.
While kids work in the sand tray, I ask questions to determine the speed and quality of their processing rate (e.g., “How big is the yucky thought now?”). Having obtained permission from the child and his/her at appropriate times. I use several slow BLSs to further install children’s references to supportive relationships (e.g., “My mom loves me”).
When children make negative references to target memories (e.g., “That was really scary”), I quickly tap multiple BLSs to help children process these negative events. This method has produced tremendous results, including inducing relaxed body postures and facial affects during and best BLS rate and type (e.g., “Would you rather watch the puppet or let it tap you?”). I conduct BLS as often as needed to help children reach 2008).
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