state with the child is a key element for healthy development and the foundational aspect for all other core elements in play therapy (Gaskill & Perry, 2017). Research suggests this attunement process creates a synchronous relationship between child and play therapist, largely accomplished through face-to-face gaze, eye-to-eye contact, and suspension of one’s own thoughts and feelings so as to “enter the world of the child” through their eyes, feelings, and thoughts (Landreth, 2012; Gaskill, 2019). A culturally competent play therapist should be sensitive to different meanings attributable to each of these ways of being. Remember, in addition to working with thoughts, feelings, and behaviors, the autonomic nervous system is playing off cues prior to the operation of those other systems.
Polyvagal theory informing mood disorders
Social withdrawal Social withdrawal or isolation often seen in childhood and adolescent depression can be met with co-regulation of the social engagement system. Co-regulation demonstrates to a play therapy client that it is safe to connect while processing a traumatic story. The play therapist creates an environment in which the child can express all feelings related to personal stories without judgment while simultaneously anchored into the present moment. In co-regulation there are two co- mingled systems: one is biologically based that drives us to connect with others and the other is a hardwired survival response. For the play therapist, this means remaining regulated to send cues of safety for
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the client. As rapport builds, the client may rely less on attempts at self-regulation, which for depressed individuals may be perceived as unsuccessful, and move toward co-regulation.
Hopelessness Hopelessness is another characteristic that often shows up in childhood mood disorders. Brené Brown (2021) writes that “hopelessness arises out of a combination of negative life events and negative thought patterns, particularly self-blame and the perceived inability to change our circumstances” (p. 101). Cognitive behavioral therapy addresses negative thought patterns during treatment (Corey, 2022). Play therapy, on the other hand, addresses hopelessness because the techniques challenge “attributions that the causes of negative events are stable and global” (Swendsen, 1997, p. 98). Alternative realities may be played out, providing a new narrative to a client’s story. Polyvagal theory adds neuroception. Neuroception describes “how neural circuits distinguish whether situations or people are safe, dangerous, or life-threatening” (Porges, 2011, p. 11). In other words, neuroception goes before conscious awareness to inform stories about ourselves and the world around us. It makes sense, then, not only to organize thought patterns through stories (as is done in sand tray therapy), but also pay attention to how the autonomic nervous system organizes story (noticing bodily responses such as heart rate, breath cycle and muscle tension).
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