Stress. Managing the Stress of play therapy practice. Play Therapy for Traumatized Clients-

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1 Play Therapy for Traumatized Clients- Using Play to Heal While Taking Care of Yourself Managing the Stress of play therapy practice Stress The perceptionthat your demands exceed your resources for dealing with them. 1

2 Behavioral Signs Sleeplessness Restlessness Tremors Avoidance of challenging situations Performance failures Emotional Signs Self-Preoccupation Irritability Anxiousness Dysphoria Depression Cognitive Signs Attention deficits Concentration difficulties Cognitive rigidity Memory failures 2

3 Physical Health A contributing factor to: hypertension, coronary artery disease, cerebral vascular accidents, ulcers, irritable bowel syndrome, rheumatoid arthritis, immune suppression, and mental illness. Physical Health Stress is a contributing factor to hypertension, coronary artery disease, cerebral vascular accidents, ulcers, irritable bowel syndrome, rheumatoid arthritis, immune suppression, and mental illness. Burnout Working Harder Neglecting your Needs Displacement of conflicts Revision (loss) of values Withdrawal Behavioral Changes Depersonalization Inner emptiness Depression 3

4 Phase 1 Building an egalitarian relationship Phase 2 Exploring the client s lifestyle Phase 3 Helping the client gain insight into his or her lifestyle Phase 4 Reorienting/re-educating the client Adjustment Disorder Acute Stress Disorder Post Traumatic Stress Disorder Reactive Attachment Disorder Disinhibited Social Engagement Disorder Type I Single event Type II Ongoing (Complex) 4

5 Criterion A: Stressor Criterion B: Intrusion Symptoms Criterion C: Avoidance Criterion D: Negative Alterations in Cognitions and Mood Criterion E: Alterations in Arousal and Reactivity Criterion F: Duration Criterion G: Functional Significance The person was exposed to: death, threatened death, actual or threatened serious injury, or actual or threatened sexual violence, as follows: (one required) 1. Direct exposure. 2. Witnessing, in person. 3.Indirectly, by learning that a close relative or close friend was exposed to trauma. If the event involved actual or threatened death, it must have been violent or accidental. 4.Repeated or extreme indirect exposure to aversive details of the event(s), usually in the course of professional duties. The traumatic event is persistently reexperienced in the following way(s): 1.Recurrent, involuntary, and intrusive memories. Note: Children older than six may express this symptom in repetitive play. 2.Traumatic nightmares. Note: Children may have frightening dreams without content related to the trauma(s). 3.Dissociative reactions (e.g., flashbacks) which may occur on a continuum from brief episodes to complete loss of consciousness. Note: Children may reenact the event in play. 4.Intense or prolonged distress after exposure to traumatic reminders. 5. Marked physiologic reactivity after exposure to traumarelated stimuli. 5

6 Persistent effortful avoidance of distressing trauma-related stimuli after the event: (one required) 1.Trauma-related thoughts or feelings. 2.Trauma-related external reminders (e.g., people, places, conversations, activities, objects, or situations). Negative alterations incognitions and mood that began or worsened after the traumatic event: (two required) 1. Inability to recall key features of the traumatic event. 2.Persistent (and often distorted) negative beliefs and expectations about oneself or the world (e.g., "I am bad," "The world is completely dangerous"). 3.Persistent distorted blame of self or others for causing the traumatic event or for resulting consequences. 4.Persistent negative trauma-related emotions (e.g., fear, horror, anger, guilt, or shame). 5. Markedly diminished interest in significant activities. 6. Feeling alienated from others (e.g., detachment or estrangement). 7.Constrictedaffect: persistent inability to experience positive emotions. Trauma-related alterations inarousaland reactivity that began or worsened after the traumatic event: 1.Irritable or aggressive behavior 2.Self-destructive or reckless behavior 3.Hypervigilance 4.Exaggerated startle response 5.Problems in concentration 6.Sleep disturbance 6

7 Heartrate? Shallow breath? Difficulty concentrating? headache? Other things? Autonomic nervous system Sympathetic nervous system - Arousing Parasympathetic nervous system - Calming Progressive Muscle Relaxation Bubble Breathing Counted Breaths Cleansing Breath Relaxation Posture Passive Stretch 7

8 Mindful Stone Counting Breaths Listen to the Bell Breathing Buddies Starfish Breathing Smell the Cookies Mind Jars 1) Create an environment of Safety, Trust, Comfort 2) Process Traumatic material 3) Encourage Social Reconnections- Hope 4) Return to pre-trauma developmental functioning Gil, Eliana Trauma- Focused Integrated Play Therapy (TF-IPT, Gil Center for Healing and Play, PLC. Fairfax, Va Intellectual Competence Knowing About Knowing How Emotional Competence 8

9 therapists ability to emotionally contain and tolerate the clinical material that emerges in treatment, their willingness and skill at detecting the intrusion of personal biases into their work, and their capacity for self-care in the context of the difficult work of psychotherapy. (Kocher & Keith-Spiegel, 2008; p. 71) Coping is any effort, healthyor unhealthy, to eliminate or reduce the unpleasant effects of stressors. Deep Sleep Physiological recuperation: Hypometabolism, and increased vasodilation Increased production of somatotrophic growth hormone 9

10 Dream Sleep Consolidation of memories De-emotionalizing of the previous day s experiences Maintenance of spatial and temporal orientation Exercise Raises HDL and lowers LDL Strengthens the heart muscle and increases the blood supply to it. Lowers blood pressure Improves immune functioning Hardens bones Increases red blood cells (oxygen carriers) Improves efficiency of mitochondria Burns stress hormones Assists in controlling the appetite Deepens sleep Active Coping Control Anticipation (Predictability) Desirability 10

11 Adding Humor because Reduces pain. Our bodies produce pain-killing hormones called endorphins in response to laughter. Strengthens immune function. Laughing increases production of T-cells, interferon and immune proteins called globulins. Decreases stress. Laughter significantly lowers cortisol levels and returns the body to a more relaxed state. Connect Capable Count Courage In order to survive and flourish, children (and adults) must develop each of the Crucial Cs: CONNECT I need to believe I have a place. CAPABLE I need to believe I can do it. COUNT I need to believe I can make a difference. COURAGE I need to believe I can handle what comes. Lew & Bettner (1998). 11

12 Observing the client doing activities Interviewing parents and/or teachers Asking client questions (in metaphor or directly) Inviting the client to role-play a problem situation Requesting the client draw a picture or tell a story Children need to connect with others. When I Connect: I feel secure. I can reach out and make friends. I Cooperate. I believe I belong. Those who do connect with others, feel secure, are able to cooperate, and can reach out and make friends. Children who do not have the skills necessary to connect will feel isolated and insecure. 12

13 Children need to feel capable. When I know I am Capable: I feel competent. I have self-control. I assume responsibility. I am self reliant. I believe I can do it. Children who do feel capable, have a sense of competence, self-control, and self-discipline. Children who do not feel capable, frequently feel inadequate and frequently try to control others or let others know that they cannot be controlled. When children are capable, they believe they can do it, and they take responsibility. They are self-reliant instead of feeling inadequate and avoiding responsibility. They have no need to seek power. Children need to know they count. When I know I count: I feel valuable. I matter. I contribute I believe I can make a difference 13

14 Children who feel that they count believe that they make a difference in the world and that they contribute in some way to others around them. Children who do not feel as though they count feel insignificant and may try to hurt back and seek revenge. Children need courage to face the future. If I have Courage: I feel hopeful. I am willing to try. I believe I can handle what comes. Children with courage face challenges with uncertain outcomes and know that they ll be okay regardless. When a child learns to read they are going to make many mistakes. A child with courage will learn more quickly because they won t give up. They will have the courage to persevere. Children who do not have courage are less likely to persevere and feel inferior to others and inadequate. 14

15 Use Your Social Support Network. In a Stanford University Medical School study with women with advanced metastatic breast cancer, those who attended weekly group meetings that allowed them to unburden themselves lived 37 additional months whereas the controls lived only 19 months. Spiegel et al. (1989). Effect of Psychosocial Treatment on Survival of Patients with Metastatic Breast Cancer. Lancet. No. 8668, ii. Embrace Meaning in Life. 15

16 Recent research suggests that religious/spiritual coping can serve to insulate individuals from stress and related physical and mental health complaints. Ashby et al., (2003). Religious Coping, Coping Resources, and Depression. Presented at the annual meeting of the American Psychological Association, Toronto, Canada. What Size is your Feeling? Mad Maracas (Goodyear-Brown, 2006) Anxiety/Worry Scaling Control Scaling Color my Emotions Circles of Safety Re-Set Button Anxiety/Worry Dance Toning Balloon Pressure Quick Draw 16

17 Problem Pass Around Worry Time and Sign Change the Channel Fortunately/ Unfortunately Talk Back to the Gremlin! Creative Characters Metaphoric Stories Creating a Sandtray 17