memory (Malchiodi, 2015; van der Kolk, 2015). In order to access this material, the right hemisphere of the brain must be accessed (Ford, 2009; Malchiodi, 2015; van der Kolk, 2015). This is where the magic of expressive forms of play therapy, such as posttraumatic play therapy, enter the clinical picture. This is not to imply play therapists assume passive roles. To the contrary, therapists must constantly monitor the play content and intervene on a continuum from less directive to more directive depending on the type of posttraumatic play that is occurring.
During trauma, the brain’s energy shifts from logical, linear, thinking parts of the brain to lower functioning regions (van der Kolk, 2015). As this energy shifts, higher functioning cognitive processes become limited and sensory processing takes over. Therefore, traumatic memories are primarily stored non-linguistically as sensory fragments, images, sensations, etc. Given that traumatic memories are stored via images, icons, symbols, and sensations, they are likely best retrieved and reprocessed through the imagery and activities of highly expressive modalities, as opposed to more cognitive, logical, and linear clinical interventions (e.g., traditional talk therapy, component-focused directive play therapy interventions).
Posttraumatic play offers one expressive mechanism by which children work through their traumatic experiences. Posttraumatic play allows children to incrementally approach their trauma by playing out aspects of their traumatic experiences (Gil, 2011, 2017). It provides them an opportunity to safely revisit and rework traumatic experiences within a more sensory and less cognitive manner.
Posttraumatic play, a natural way of healing post-trauma, allows a traumatized child to show his or her inner world in an exposed, yet shielded, way (Gil, 2011, 2017). Although not all children utilize posttraumatic play, therapists must be aware of its existence and recognize that it is a form of gradual exposure by which the child obtains incremental introduction to feared aspects of traumatic events. Within the safety and containment of the therapeutic relationship, posttraumatic play allows the child the opportunity to manage and tolerate feelings, sensations, and memories associated with his or her trauma. Posttraumatic play allows the creation of a narrative that is coherent, accurate, and meaningful through retelling and reprocessing. As the posttraumatic play unfolds, meaning-making increases and posttraumatic symptoms decrease. The overarching goals are to develop control and facilitate mastery.
According to Gil (2011, 2017), there are two types of posttraumatic play: dynamic and toxic. Dynamic posttraumatic play has movement and allows the child to achieve a sense of mastery. In contrast, toxic posttraumatic play becomes stuck and is without movement, relief, or release. Although the exact mechanisms by which toxic posttraumatic play occurs are not known, it is speculated that the distance and safety the play was providing becomes compromised in some manner and, instead of providing shelter, the play becomes traumatizing. The phenomenon of toxic posttraumatic play is believed to occur at the point where the play loses its protective capacity.
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Due to its potential to be retraumatizing, toxic posttraumatic play may require the therapist to assume a more directive role. The play therapist’s level of directivity may vary from less directive to more directive based on the level of toxicity in the child’s posttraumatic play and the therapist’s clinical judgement. Adapted from Gil’s (2017) work, a possible continuum of clinical intervention from least to most directive might include: employing trauma-informed descriptive statements, using trauma-informed labeling of emotions, giving characters a voice, “wondering” (e.g., “I wonder what could happen to protect the baby bear.”), offering options, changing/intervening in the sequence of play, requesting physical movement/breathing, using reflective mirrors, writing or drawing story boards, or suggesting video recording (Kenney- Noziska, 2018).
14 | PLAYTHERAPY June 2019 |
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Dynamic and toxic posttraumatic play are conceptualized to occur on (2017) more clearly articulated a framework for exploring whether a child’s posttraumatic play is dynamic or toxic in her most recent and comprehensive publication on posttraumatic play. On this continuum, an example of dynamic posttraumatic play might include play in which the story starts/ends differently, has new information/characters, and has the presence of new themes. In contrast, toxic posttraumatic play might include a rigid story where no new outcomes emerge, and no new characters are introduced. In regard to the relationship, a client engaged in dynamic posttraumatic play may seek interaction with the clinician and be available for emotional connection; by contrast, a child engaged in toxic posttraumatic play would more likely be engaged in focused, isolated play and be unavailable for connection.
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