Parent focused sessions are needed to help the therapist build an alliance with the parental system and to help secure commitment to treatment. During parent focused sessions the therapist provides a safe space for the parental system to express their concerns and needs (Furrow et al., 2019). The therapist can build strong therapeutic alliances by providing validation when exploring parental attachment and emotional histories, as well as parental guilt (Lebow, 2005). The therapist explores parental feelings of safety in their own childhood to help understand the systemic for positive outcomes, as parental mood disorder can create caregiving blocks which the child perceives as a lack of availability and then responds with self-protective strategies. Parental history of mood disorder has a strong bearing on the likelihood the child developing a mood disorder as well (Kobak & Mandelbaum, 2003).
For our child clients to experience safety outside of the therapeutic
relationship, the therapist likely needs to work with the parental system and
anchor in ventral while doing so. Working with parents can be intimidating, thus activating the play therapist’s sympathetic or dorsal system.
Another important concept is that the therapist processes the family interaction based on what is observed in the session, not what is reported by the family (Lebow, 2005). The therapist creates an environment where the family is free to engage so that the natural patterns of interactions emerge. Play therapists can creatively facilitate this intervention through family play with or without a directive. For example, a family could create a sandtray with a directive of sculpting their family or the family could be free to build and construct what they desire, while the therapist observes the natural interaction patterns as they emerge. Art and creative interventions can also be used, perhaps guiding the family as they create a collage of their family system, family interest or pictures that represent parts of the family. Playful family therapy sessions allow the therapist to observe the flow of family interaction including the presence or lack of cohesion and/or disengagement between various family members. According to Furrow et al. (2019), when a child is exposed to frequent unresolved parental conflict the child may experience enduring negative emotions and heightened anxiety about family stability. A play therapist should consider recommending couple therapy if the couple's distress is
Tying the two systems together Safety is the key to effective treatment of mood disorders in play therapy. Cues of safety have the capacity to heal the nervous system and the relationship for the parent and the child (Porges & Dana, 2018). According to Porges (2011) play blends the social engagement system and the
26 | PLAYTHERAPY | Spetember 2022 |
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sympathetic system increasing the adaptability of the nervous system. The play therapist can create safety by facilitating family play therapy sessions. The play therapist uses reflecting and tracking of the interaction pattern, highlighting the blocks between the parent and child throughout the play. The therapist verbalizes and tracks the activated autonomic state in this pattern, as well as regulation in the moment to develop the skill of adaptability (Porges & Dana, 2018). Using play therapy with the family the likelihood of family conflict with childhood mood disorders (Stapp et al., 2020) creating opportunities for connection may cultivate therapeutic the child and the family. Mindfulness play can help clients feel less anxious, more attuned, and have more self-acceptance (Kestly, 2014). The play therapist can also help educate the child and parental team on the circuits of the brain by painting Dan Siegel’s ‘hand model of the brain’ (as cited in Kestly, 2014) on their own hands or one another’s hands, playfully engaging with psychoeducational material.
To help foster emotional safety within the therapeutic relationship therapists need to anchor themselves in ventral while in session (Porges use; this can be done during telehealth as well. Anchoring starts with self-awareness, thus the therapist needs to observe and deepen their dorsal, the therapist self-soothes to return to ventral. This is necessary to help co-regulate the family and bring the family into ventral. Building from the relational interaction assessments listed above, the play therapist can help the family experience ventral and increase the percentage of these experiences between sessions. Dana (Integrative listening system, 2021, July 11) explained that even micro minutes in ventral can bring healing to the nervous system.
For our child clients to experience safety outside of the therapeutic relationship, the therapist likely needs to work with the parental system and anchor in ventral while doing so. Working with parents can be intimidating, thus activating the play therapist’s sympathetic or dorsal system. When the play therapist comes from a place of curiosity and compassion, as opposed to judgement, emotional safety is developed within this therapeutic relationship. In my experience, parents are doing the best they can at any given time. Many of the parenting systems I have worked with have their own history of traumas and their nervous systems need to be co-regulated as well. Giving parents a place of safety,
Balancing multiple alliances when working with an entire family system may be challenging. When working with a large family, it is important to target the most distressing dyad (Furrow et al., 2019; Lebow, 2005). Targeting the smaller system can help build security and safety with the entire family system and help maintain attention to the ebb and flow of the therapeutic alliance with each member and the family system (Furrow et al., 2019). The play therapist can use these concepts to address the internal system needs for parents and child alike, while also addressing the family system as a whole.
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