regulation skills. Clinically, a play therapist may see a child with a primary mood disorder such as bipolar, dysregulated mood disruptive disorder, or major depressive disorder, while other times there may be a secondary mood disorder, perhaps associated with ADHD or autism. Regardless of the etiology, a play therapist can build on play therapy theoretical orientations by utilizing polyvagal theory (Porges, 2019) and relational based treatment (Furrow et al., 2019; Schenkel et al., 2008; Stapp et al.,
W
Looking through the polyvagal lens Understanding state regulation can inform the play therapist of brain- of mood dysregulation. Physiological experiences are a fundamental part of emotion and moods. According to polyvagal theory (Porges & Dana, 2018; Porges, 2021) when various levels of the hierarchical system in the brain and body including ventral, sympathetic, and dorsal become A key concept of polyvagal theory is neuroception, which Porges and Dana described as “three distinct autonomic, visceral, and somatic states signaling safety, danger, and life-threat” (2018, p. 3). Another term a “sense that is normally stimulated from within the body. This involves numerous sensory receptors in the muscles and in the internal organs. These receptors are neurologically linked to nuclei in the brainstem as part of a complex feedback system” (Porges & Dana, 2018, p 4). The body is continually assessing the environment for cues of safety and danger. response, or a shut down response.
Deb Dana developed a visual aid of the autonomic ladder to illustrate how a person moves in and out of these different states (Porges & Dana, 2018, Figure 11.1). At the top of the ladder is ventral, which is the social engagement system. In this state a person would generally feel safe, connected, and engaged. When this system goes offline due to a perceived threat the next rung of the ladder is accessed as the body for movement. When a child is in the sympathetic state, behaviors may include hyperactivity, aggression, withdrawal, and affect limitations. When the sympathetic system goes offline because of a life threat, the next rung of the ladder is accessed as the dorsal system activates and the body becomes immobilized and collapses. The dorsal state presents as a depressive, dissociative, suicidal, and isolated state.
Acknowledging the hierarchical structure of these systems allows the play therapist to identify the reciprocity between internal and external systems. Porges described individuals with trauma experiences as existing in a 'terrorizing trap’ vacillating between sympathetic and
orking with a child with dysregulated moods can seem daunting, leaving a play therapist feeling uncertain about how to help. Play therapy can provide a pathway for the client to develop self-
CLINICAL EDITOR’S COMMENTS:
Creating safety with the child client and the family system is critical to improving mood disorders with play therapy.
individuals experience mood dysregulation, it is arduous for the person’s biological system to move smoothly in and out of these states (i.e., ventral, sympathetic, dorsal). The goal of therapeutic intervention is not to help the client stay in the ventral state, which is impossible, but to support the client’s self-awareness of which state is activated and experience adaptive flexibility to seamlessly move into and out of these
Therapists now have a clear understanding of the reciprocity
within and between relationships, so assessing these dynamics can inform treatment
When a child has mood dysregulation needs, understanding how the child moves in and out of these systems can inform and support caregivers as well. A play therapist who is family systems informed will also assess how the parents experience and respond in their own state, deepening the understanding of the needs in the child and the child’s family system. When working with the family system, one of the initial goals is expanding parental instincts by shifting the parent perspective from pathologizing and blaming the client to strengthening family relationships through building relational connections as a solution to the problem (Furrow et al., 2019). This prepares the family to repair misattunement and misconceptions in the future.
Assessing the family system Relational based therapies are supportive for children with mood disorders (Schenkel et al., 2008), and including and engaging the family and the parental dyad is vital when supporting children in therapy (Furrow et al., 2019; Lebow, 2005). Therapists now have a clear understanding of the reciprocity within and between relationships, so assessing these dynamics can inform treatment (Furrow et al., 2019; Porges & Dana, 2018; Porges, 2021) however assessing mood dysregulation in the parental dyad, sibling group, and the grandparent system may be overlooked by play therapists (Cates et al., 2006). It is crucial for the play therapist to provide emotional safety to caregivers and develop a working alliance as this partnership is the foundation of therapeutic change within the family system (Furrow et al., 2019).
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