begin to understand his own feelings and impulses. This would also be necessary for me to begin to help his mother gain insight into how she was interwoven into this dynamic.


Having received training in Adlerian Play Therapy (AdPT), attachment theory and family systems theory, I take a prescriptive play therapy approach that has been supported by IPNB constructs. Remaining grounded in my professional identity prepared me to be responsive to Jayden and his mother using a range activities that promoted self-expression, emotional intelligence, sensory integration and understanding the impact of unmet belonging needs. From this perspective, I was able to rely on play therapy skills like reflecting content and feeling as an empathy offering for Jayden’s spoken and unspoken desire for connection.


Nervous system to nervous system co-regulation was more involved throughout the next action-packed session. As our time was winding down, I had prepared for Jayden’s struggles with transitions and presentedhim with abubblewandwhile inviting himtostand approximately three feet from the playroom door. In response to my acknowledgingJayden’spreferences formovementand activities with rapid changes, he was receptive to this direction. He remained by my side and visually checked in with me as he anticipated each next step. Through verbal prompts and gestures toward the door, I encouraged him to take one jump at a time towards the door and then blow bubbles until they touched the door, which could not happen


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from that distance. This was intentional and provided an opportunity for building relational connection. Standing right beside Jayden, I looked at him, narrated, encouraged him to jump forward and try again. Together we moved closer and examined where the bubbles             put his jacket on, a step in our transition which had previously been dysregulating for him. We opened the playroom door and continued this curated pattern down the hallway until we arrived at the next door. After creating bubble marks on the waiting room door, Jayden easily transitioned to holding hands with his mother, Veronica. Her teary eyes expressed hope and relief, and together she and Jayden walked peacefully out of the building.


Alternatingbetween ritual andspontaneous playfulexpression


became Jayden’s pattern in therapy. The predictability of our structure, sensory integration support and attunement (a deep emotional connection during a shared experience that allows the other person to “feel felt” (Siegel & Bryson, 2012)) laid the groundwork for Jayden to experience the “Four S’s”: Safe, Seen, Soothed and Secure (Siegel & Bryson, 2020). This helped increase Jayden’s internalized regulation, a skill that largely develops from attunement.


Liana Lowenstein, MSW Edited by


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In retrospect, when I think of moments shared with Jayden, I also think of a quote from The Body Keeps the Score: “When we enter the world, we scream to announce our presence,” (Van der Kolk, 2015, p. 91).


Jayden was in a more receptive state during future sessions, but I still felt something was missing. It was not until I asked Veronica about her own experiences that the missing context was shared.           stress and intense verbal altercations, which had not been previously disclosed. Veronica seemed surprised, confused even, by my follow    altercations and was being held in her arms as an infant for others. I had compassion for her, as she too was emotionally influenced by the highly charged relationship. My work supporting Jayden began to include psychoeducation during parent consultations. Early in our therapeutic relationship the focus was on content and affect during parent-child interactions but later included underpinnings of positive          own history and emotions, which enabled her to be a more capable and active participant in her son’s treatment. She began to facilitate Jayden’s transition ritual and expressed having more energy to “connect then redirect,” which positively impacted Jayden’s behaviors outside of session. Veronica was developing an understanding of how her emotions and memories, influenced by her own relationship history, tended to impact her interactions with Jayden. Her growing mindsight or, “understanding (of one’s) own mind as well as understanding the mind of another,” (Siegel & Bryson, 2012, p. 93) was supporting her own, as well as her son’s, healthy development. One day Veronica entered session smiling and shared some positive progress in her personal life which she reported was motivated by our therapeutic relationship. She had begun to realize how shifting the perception of her own story was creating space for Jayden.


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