2013). Autonomy is one of the basic tenets of counseling and the desire for autonomy is particularly prominent in teens, so in addition to meeting needs for novelty, it is essential to provide choices and tailor the sessions to individual needs based on treatment goals (Bratton et al., 2016; Erickson, 1959; Leggett & Boswell, 2017). For some teens, already be engaged in creative interests. Meeting teens where they are allows play therapists to leverage existing interests to build the therapeutic relationship, enhance autonomy, and help them explore the
Neuroimaging indicates a changing balance between the limbic and frontal lobe activation in the teen brain could contribute to the stark emotional and behavioral volatility in teens (Jensen, 2005; Giedd, 2008). An important role of the prefrontal cortex is the ability to plan and recognize the consequences of one’s behaviors. The amygdala, part of the limbic system, plays a major role with emotions, aggression, and instinctual responses (Giedd, 2008). The prefrontal cortex does not appear to fully mature until about the age of 24 years old, while the amygdala is found to mature earlier which could contribute to teens’ impulsivity, sensation seeking, emotionality, and this stage of development (AAP, 2019; Arain et al., 2013; Giedd, 2008; Jensen, 2005). Maturing limbic and cortical brain areas are also vulnerable to the shifts in the hypothalamic-pituitary-adrenal (HPA) axis, which results in stress-induced hormone responses and emotional shifts in teens (Romeo, 2013). Fortunately, the plasticity of the teen brain offers a window of opportunity for influence (Giedd, 2008; Olson et al., 2008).
Mental health issues in teens are an urgent concern, as more than 1 in 20 U.S. children aged 6-17 years will have anxiety or depression diagnosed by a healthcare provider (CDC, 2022; Romeo, 2013). Fortunately, teens tend to consider counselors and other healthcare providers to be credible and trustworthy, which is critical
to the
success of any intervention (Olson et al., 2008). Since the teen is experiencing stress, brain changes, puberty, sexual development, peer pressure, and hormonal
fluctuations (Jensen, 2005; Romeo,
2013), the consistency of an understanding, creative, and well-trained play therapist can help to calm this perfect storm using expressive clients (Hudspeth & Matthews, 2016). While in-person counseling replace, real-life interactions (Zilberstein, 2015). Online counseling increases treatment accessibility,
reduces service-related stigma,
and has the potential as an effective treatment for a variety of teen mental health presentations (Sweeney et al., 2019; Zhou et al., 2021). The use of
technology provides a familiar medium for
teens, who are able to present themselves more authentically and honestly as the screen provides therapeutic distance and a sense of safety (Hull, 2016; Olson et al., 2008; Stone, 2019). As the digital technology age continues to evolve, it is important for counselors to recognize that the youth of today are ‘born with technology in their
CLINICAL EDITOR’S COMMENTS:
Teleplay therapy can meet the needs of teenagers with an understanding of the interrelatedness of social and emotional needs and brain development.
hands;’ technology is experienced as an extension of who they are as opposed to a tool (Barker, 2021).
Expressive and creative methods have the capacity to provide a mental scaffold and support the development and needs of the teen brain in play therapy as they capture the teen’s attention and provide needed evidence-based interventions to support treatment goals including decreasing symptoms of depression and anxiety and increasing responsiveness and healing (Barker, 2021; Bratton et al., 2016; Hudspeth & Matthews, 2016; Olson et al., 2008; Romeo, 2013; Stauffer, 2021). Both authors utilize directive and non-directive play therapy approaches in teleplay therapy. In non-directive play, the play therapist is guided by the child and questions are minimal to none. Digital play can be utilized in non-directive teleplay therapy, however, it is important that the play therapist research any games the client may be using for appropriateness, limit setting, and to minimize questions. Teens can also prepare with their own items that they would like to use during the session. In a directive approach, the play therapist guides the activities, play and digital toy adaptations, and game apps that may be used. The creative teleplay therapy activities presented in the article can be used with various theoretical orientations and are intended to support teens in their emotional expression. These may include the use of online sandtray therapy, the GoNoodle app, guided imagery, music, Tik Toks, computerized or material art projects, and scavenger hunts.
Ethical Considerations There are a variety of ethical challenges that arise with teleplay therapy with teens. These include protecting the teen’s privacy. It is important to discuss where any expressive materials will be housed when complete to ensure that their privacy is respected.
The following are play therapy best practices when using technology and web-based applications in session (Association for Play Therapy, 2020): social media with client.
• Ensure that the technology being used is developmentally
as the treatment goals.
use of technology and make all possible efforts to protect the client’s identity.
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