Neuroscience provides play therapists a shared language for physiological changes (biomarkers) therapy.
supportive of effective play In short, neuroscience provides evidence unifying and
validating much of what has historically been theorized. It has become the intersection connecting our past to our future. The current article play therapy practice with traumatized children.
1. Play Therapy Must Consider Relational Qualities The human brain seeks warmth, comfort, belonging, protection, and safety through relationships, since at a primal level, relationships are major determinants of growth, development, and survival (Pankseep & Bevin, 2012; Szalavitz & Perry, 2010). The play therapy process must be rooted in a relationally rich and supportive environment compatible with the functional age. Healthy relationships are essential for successful development and treatment (Shirk & Karver, 2011).
Play therapists
must place maximum value on the creation of warm, genuine, authentic relationships, throughout the child’s larger relational environment of home, school, and community (therapeutic web). Human beings have never survived or thrived well alone, especially children (Szalavitz & Perry, 2010).
It is imperative that children be immersed in a nurturing, healthy,
positive, encouraging and understanding social milieu. These factors fuel developmental progress more than eliminating negative behaviors. Only new learning (new and stronger neural connections) support new concepts, thoughts, and behaviors to modulate impulses or prior learning. Consequently, relationships (family, school, friends, therapist, and community) are vital to learning and development and the best predictor of treatment outcome. The most effective play therapy interventions emanate through this healthy therapeutic web (Ludy-Dobson & Perry, 2010). As Shirk and Karver (2011) pointed out, the value of the relationship may be more important than reward or technique. When two people are in an attuned relationship, brain waves, hormones, heart rates, and other body systems synchronize creating the optimal ability to understand each other, experience empathy, and learn from each other (Panksepp & Bevin, 2012). This is the most powerful therapeutic impact play therapists can create. Without it, positive therapeutic change is likely incomplete and less successful (Saeri et al., 2018). Further, it should be noted the ratio of adults to children changes as a function of age or perception of threat. Infants have a strong preference for one-to-one relationships with their primary caregivers. Therapists must be cognizant of the child’s functional age as the psycho-social ratio will influence intervention effectiveness throughout the therapeutic web.
The more immature
the functional age, the more likely that a one-to-one relationship will be required, especially when distressed. Creating a therapeutic relationship
2. Play Therapists Must Understand What Is
Rewarding to The Child Human beings seek reward in many forms, being brain region dependent. Different regions respond to different types of rewards.
The most powerful query assessed by a traumatized child is: “Am I safe?” The answer to this question is unconsciously answered through low brain “implicit memory” of similar past experiences. Novel experiences often produce fear as there is no comparative experience. Being wary is a good precaution. Until the Hypothalamic, Pituitary, Adrenal Complex (HPA) or educational agenda will fail (Gaskill & Perry, 2017). This is a critical item for therapists to keep in mind as many well-planned treatment strategies failed when “therapy” began before the child felt safe.
To support recovery, play
therapy must replicate the normal developmental progression of
experiences, beginning at the lowest disorganized brain region for optimal outcome (Perry & Dobson, 2013).
The operative reward system changes as arousal escalates (Perry, 2020). When children are calm, cortex issues of beliefs, values, and logic more likely prevail. When an alert state exists, children focus on relationships (friends, positive peer group,
trusted individuals),
predominately mediated through cortex and limbic systems. Alarm states focus on physical and sensory rewards such as salt, fat, sugar, mediated by the limbic system.
Further escalation of the stress
response system focuses on fear states, mediated by diencephalon and brainstem functions, resulting in escape urges (avoiding, fleeing, mechanisms result in dissociation, rocking, head banging, self- mutilation, or similar behaviors also mediated by the low brain.
www.a4pt.org | June 2022 | PLAYTHERAPY | 5
CLINICAL EDITOR’S COMMENTS:
elements that unify and validate play therapy across theories.
Play therapists must grasp this principle to create positive change. As stated earlier, the human brain seeks safe, supportive, and nurturing relationships which are valued more than material reward. Relational factors have been found the best predictor of outcome (Hambrick, Brawner, Perry, Brandt, Hofmeister, & Collins, 2019).
This suggests
problems with contingency management programs as they generally emphasize set material rewards (stickers, token economy, money etc.). Play therapists must remember that low brain arousal will dictate what is or is not viewed as rewarding (Perry, 2020).
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