a mechanism to access and reprocess traumatic memories, integrate body sensations, and regulate physiology. There is clinical utility in integrating both approaches to reduce symptoms and improve posttraumatic functioning for children through play therapy.
Overview of an Integrative Approach Findings from the adverse childhood experiences (ACEs) study, the the strong relationship between childhood trauma and an array of adverse consequences across the life span (Center for Disease Control and Prevention, 2019; Felitti, et al., 1998; Greeson, et al., 2014; Mersky, Topitzes, & Reynolds, 2013). Adverse consequences include the emergence of medical conditions, mental health disorders, substance abuse problems, revictimization, and premature mortality. The ACEs study underscores the cumulative impact of childhood trauma and the risk of serious consequences if intervention is not received.
As a result of the overwhelming nature of childhood trauma, play therapists can be left wondering where to begin. Historically, the play play therapists are trained in and operate from one primary theoretical play therapy orientation (Kenney-Noziska, Schaefer, & Homeyer, 2012). However, given the complex needs of trauma victims, an integrative play therapy approach may be more appropriate. An integrative approach emphasizes blending various play therapy theories and techniques versus theoretical consistency (Drewes, 2011; Seymour, 2011). Indeed, to the client’s individual needs versus allegiance to one model (Kenney- Noziska, Schaefer, & Homeyer, 2012).
Congruent with this, several play therapy and expressive approaches to trauma treatment echo the need for a continuum of expressive interventions. When using posttraumatic play therapy, Gil (2011, 2017) suggested that the play therapist not adhere to a single approach, yet, instead, recognize the importance of flexibility in being more or less directive based on the child’s needs. Additionally, given the natural tendency to avoid painful memories, she reminded clinicians that the sole use of nondirective play may not be as effective. Steele and Malchiodi (2012) discussed the importance of having a trauma- and medicine. From this perspective, clinicians recognize that trauma affects both the mind and the body. In other words, trauma is as much a physiological phenomenon as it is a psychological one. TraumaPlay™, a flexibly sequential play therapy model that combines both directive and non-directive methods, is another integrative trauma-informed framework (Goodyear-Brown, 2010, 2019) that
is grounded in an
understanding of the neurobiology of trauma and the neurobiology of play and the power of one to heal the other. TraumaPlay™ offers a series of treatment goals that mirror those of other evidence-based trauma models, such as trauma-focused cognitive behavioral therapy (TF-CBT), while delivering treatment primarily through play-based interventions.
CLINICAL EDITOR’S COMMENTS: The author further delineates dynamic
and toxic posttraumatic play and how play therapists can help through an integrative approach.
victims of childhood abuse and trauma, where is the starting point? the “Decade of the Brain” (i.e., 1990 – 1999; Goldstein, 1994) provide play therapists with foundations to begin case conceptualization and to move forward with integrating directive and posttraumatic play therapy.
Directive Play Therapy Interventions The evidence-based treatment (EBT) movement, which emphasizes population (Fitzgerald & Berliner, 2018), has helped develop more effective trauma interventions. The National Child Traumatic Stress Network (NCTSN) has termed the areas of overlap for evidence-based protocols “core components” (NCTSN, 2019). Core components include intervention objectives which provide targets for trauma treatment. These core components include psychoeducation, management of anxiety, dealing with trauma and loss reminders, trauma narration and organization, cognitive and affective labeling and processing, emotional regulation, and problem-solving regarding safety and relationships (NCTSN, 2019).
Core treatment components provide a foundation for directive play therapy interventions and techniques. Examples might include the purposeful use of clinical games, structured puppet interviews, or sandtray directives. When used with intention, directive play therapy to generate coping strategies for managing posttraumatic stress and reactions, to recognize triggers, to explore and address trauma- safety. Directive play therapy interventions and techniques provide the opportunity for clients to rehearse skills and to develop relapse prevention strategies; both of which are components of being evidence- based and trauma-focused (Fitzgerald & Berliner, 2018).
Posttraumatic Play Therapy Despite the value of using directive play therapy to target core components of trauma treatment, there are limitations to adhering strictly to component-focused interventions. The neurobiology of trauma suggests that most traumatic material is not encoded as explicit, contextual memory but,
instead,
is embedded in implicit
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