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Psychological and Physiological Trauma Research
Seize Your Journeys
_______________________ Traumatic stress is found in many competent, healthy, strong, good people. No one can completely protect themselves from traumatic experiences. Many people have long-lasting problems following exposure to trauma. Up to 8% of persons will have PTSD at some time in their lives. People who react to traumas are not going crazy. What is happening to them is part of a set of common symptoms and problems that are connected with being in a traumatic situation, and thus, is a normal reaction to abnormal events and experiences. Having symptoms after a traumatic event is NOT a sign of personal weakness. Given exposure to a trauma that is bad enough, probably all people would develop PTSD. By understanding trauma symptoms better, a person can become less fearful of them and better able to manage them. By recognizing the effects of trauma and knowing more about symptoms, a person will be better able to decide about getting treatment. _______________________
Secure Attachments as a Defense Against Trauma “All people mature and thrive in a social context that has profound effects on how they cope with life’s stresses. Particularly early in life, the social context plays a critical role in fuffering an individual against stressful situations, and in building the psychological and biological capacities to deal with further stresses. The primary function of parents can be thought of as helping children modulate their arousal by attuned and well-timed provision of playing, feeding, comforting, touching, looking, cleaning, and resting—in short, by teaching them skills that will gradually help them modulate their own arousal. Secure attachment bonds serve as primary defenses against trauma-induced psychopathology in both children and adults (Finkelhor & Browne, 1984). In children who have been exposed to severe stressors, the quality of the parental bond is probably the single most important determinant of long-term damage (McFarlane, 1988).” van der Kolk, Bessel, Alexander C. McFarlane, and Lars Weisaeth, eds. 1996. Traumatic stress: The effects of overwhelming experience on mind, body, and society. New York and London: Guilford Press. .p. 185
Eating Disorders “The Eating Disorders are characterized by severe disturbances in eating behavior. This section includes two specific diagnoses, Anorexia Nervosa and Bulimia Nervosa. Anorexia Nervosa is characterized by a refusal to maintain a minimally normal body weight. Bulimia Nervosa is characterized by repeated episodes of binge eating followed by inappropriate compensatory behaviors such as self-induced vomiting; misuse of laxatives, diuretics, or other medications; fasting; or excessive exercise. A disturbance in perception of body shape and weight is an essential feature of both Anorexia Nervosa and Bulimia Nervosa. An Eating Disorder Not Otherwise Specified category is also provided for coding behaviors that do not meet criteria for a specific Eating Disorder. Simple obesity is include in the International Classification of Diseases (ICD) as a general medical condition but does not appear in DSM-IV because it has not been established that it is consistently associated with a psychological or behavioral syndrome. However, when there is evidence that psychological factors are of importance in the etiology or course of a particular case of obesity, this can be indicated by noting the presence of Psychological Factors Affecting Medical Condition. Disorders of Feeding and Eating that are usually first diagnosed in infancy or early childhood (i.e., Pica, Rumination Disorder, and Feeding Disorder of Infancy or Early Childhood) are included in the section “Feeding and Eating Disorders of Infancy or Early Childhood. Anorexia Nervosa Diagnostic Features The essential features of Anorexia Nervosa are that the individual refuses to maintain a minimally normal body weight, is intensely afraid of gaining weight, and exhibits a significant disturbance in the perception of the shape or size of his or her body. In addition, postmenarcheal females with this disorder are amenorrheic. (The term anorexia is a misnomer because loss of appetite is rare.) The individual maintains a body weight that is below a minimally normal level for age and height (Criterion A). When Anorexia Nervosa develops in an individual during childhood or early adolescence, there may be failure to make expected weight gains (i.e., while growing in height) instead of weight loss. Criterion A provides a guideline for determining when the individual meets the threshold for being underweight. It suggests that the individual weigh less than 85% of that weight that is considered normal for that person’s age and height (usually computed using one of several published versions of the Metropolitan Life Insurance tables or pediatric growth charts.). An alternative and somewhat stricter guideline (used in the ICD-10 Diagnostic Criteria for research) requires that the individual have a body mass index (BMI) (calculated as weight in kilograms/height in meters2) equal to or below 17.5kg/m2. These cutoffs are provided only as suggested guidelines for eh clinician, since it is unreasonable to specify a single standard for minimally normal weight that applies to all individuals of a given age and height. In determining a minimally normal weight, the clinician should consider not only such guidelines but also the individual’s body build and weight history. Usually weight loss is accomplished primarily through reduction in total food intake. Although individuals may begin by excluding from their diet what they perceive to be highly caloric foods, most eventually end up with a very restricted diet that is sometimes limited to only a few foods. Additional methods of weight loss include purging (i.e., self-induced vomiting or the misuse of laxative or diuretics) and increased or excessive exercise.) Individuals with this disorder intensely fear gaining weight or becoming fat (Criterion B). This intense fear of becoming fat is usually not alleviated by the weight loss. In fact, concern about weight gain often increases even as actual weight continues to decrease. The experience and significance of body weight and shape are distorted in these individuals (Criterion C). Some individuals feel globally overweight. Others realize that they are thin but are still concerned that certain parts of their bodies, particularly the abdomen, buttocks, and thighs are “to fat.” They may employ a wide variety of techniques to estimate their body size and weight, including excessive weighing, obsessive measuring of body parts, and persistently using a mirror to check for perceived areas of “fat.” The self-esteem of individuals with Anorexia Nervosa is highly dependent on their body shape and weight. Weight loss is viewed as an impressive achievement and a sign of extraordinary self-discipline, whereas weight gain is perceived as an unacceptable failure of self-control. Though some individuals with this disorder may acknowledge being thin, they typically deny the serious medical implications of their malnourished state. In postmenarcheal females, amenorrhea (due to abnormally low levels of estrogen secretion that are due in turn to diminished pituitary secretion of follicle-stimulating hormone [PSH] and luteinizing hormone [LH]) is an indicator of physiological dysfunction in Anorexia Nervosa (Criterion D.) Amenorrhea is usually a consequence of the weight loss but, in a minority of individuals, may actually precede it. In prepubertal females, menarche may be delayed by the illness. The individual is often brought to professional attention by family members after marked weight loss (or failure to make expected weight gains) has occurred. If individuals seek help on their own, it is usually because of their subjective distress over the somatic and psychological sequelae of starvation. It is rare for an individual with Anorexia Nervosa to complain of weight loss per se. Individuals with Anorexia Nervosa frequently lack insight into, or have considerable denial of, the problem and may be unreliable historians. It is therefore often necessary to obtain information form parents or other outside sources to evaluate the degree of weight loss and other features of the illness.” p. 583-584. Bulimia Nervosa “Diagnostic Features The essential features of Bulimia Nervosa are binge eating and inappropriate compensatory methods to prevent weight gain. In addition, the self-evaluation of individuals with Bulimia Nervosa is excessively influenced by body shape and weight. To qualify for the diagnosis, the binge eating and the inappropriate compensatory behaviors must occur, on average, at least twice a week for 3 months (Criterion C.) A binge is defined as eating in a discrete period of time an amount of food that is definitely larger than most individuals would eat under similar circumstances (Criterion A1.). The clinician should consider the context in which the eating occurred—what would be regarded as excessive consumption at a typical meal might be considered normal during a celebration or holiday meal. A “discrete period of time” refers to a limited period, usually less than 2 hours. A single episode of binge eating need not be restricted to one setting. For example, an individual may begin a binge in a restaurant and then continue it on returning home. Continual snacking on small amounts of food throughout the day would not be considered a binge. Although the type of food consumed during the binge varies, it typically includes sweet, high-calorie foods such as ice cream or cake. However, binge eating appears to be characterized more by an abnormality in the amount of food consumed than by a craving for a specific nutrient, such as carbohydrate. Although individuals with Bulimia Nervosa consume more calories during an episode of binge eating than persons without Bulimia Nervosa consume during a meal, the fractions of calories derived from protein, fat, and carbohydrate are similar. Individuals with Bulimia Nervosa are typically ashamed of their eating problems and attempt to conceal their symptoms. Binge eating usually occurs in secrecy, or as inconspicuously as possible. An episode may or may not be planned in advance and is usually (but not always) characterized by rapid consumption. The binge eating often continues until the individual is uncomfortably, or even painfully, full. Binge eating is typically triggered by dysphoric mood states, interpersonal stressors intense hunger following dietary restraint, or feelings related to body weight, body shape, and food. Binge eating may transiently reduce dysphoria, but disparaging self-criticism and depressed mood often follow. An episode of binge eating is also accompanied by a sense of lack of control (Criterion A2). An individual may be in a frenzied state while binge eating, especially early in the course of the disorder. Some individuals describe a dissociative quality during, or following, the binge episodes. After Bulimia Nervosa has persisted for some time, individuals may report that their binge-eating episodes are no longer characterized by an acute feeling of loss of control, but rather by behavioral indicators of impaired control, such as difficulty resisting binge eating or difficulty stopping a binge once it has begun. The impairment in control associated with binge eating in bulimia Nervosa is not absolute; for example, an individual may continue binge eating while the telephone is ringing, but will cease if a roommate or spouse unexpectedly enters the room. Another essential feature of Bulimia Nervosa is the recurrent use of inappropriate compensatory behaviors to prevent weight gain (Criterion B). Many individuals with Bulimia Nervosa employ several methods in their attempt to compensate for binge eating. The most common compensatory technique is the induction of vomiting after an episode of binge eating. This method of purging is employed by 80%-90% of individuals with Bulimia Nervosa who present for treatment of eating disorders clinics. The immediate effects of vomiting include relief from physical discomfort and reduction of fear of gaining weight. In some cases, vomiting becomes a goal in itself, and the person will binge in order to vomit or will vomit after eating a small amount of food. Individuals with Bulimia Nervosa may use a variety of methods to induce vomiting, including the use of fingers or instruments to stimulate the gag reflex. Individuals generally become adept at inducing vomiting and are eventually able to vomit at will. Rarely, individuals consume syrup of ipecac to induce vomiting. Other purging behaviors include the issue of laxatives and diuretics. Approximately one-third of those with Bulimia Nervosa misuse laxatives after binge eating. Rarely, individuals with the disorder will misuse enemas following episodes of binge eating, but this is seldom the sole compensatory method employed. Individuals with Bulimia Nervosa may fast for a day or more or exercise excessively in an attempt to compensate for binge eating. Exercise may be considered to be excessive when it significantly interferes with important activities, when it occurs at inappropriate times or in inappropriate settings, or when the individual continues to exercise despite injury or other medical complications. Rarely, individuals with this disorder may take thyroid hormone in an attempt to avoid weight gain. Individuals with diabetes mellitus and Bulimia Nervosa may omit or reduce insulin doses in order to reduce the metabolism of food consumed during eating binges. Individuals with Bulimia Nervosa place an excessive emphasis on body shape and weight in their self-evaluation, and these factors are typically the most important ones in determining self-esteem (Criterion D). Individuals with this disorder may closely resemble those with Anorexia Nervosa in their fear of gaining weight, in their desire to lose weight, and in the level of dissatisfaction with their bodies. However, a diagnosis of Bulimia Nervosa should not be given when the disturbance occurs only during episodes of Anorexia Nervosa (Criterion E).” p. 589-591
Diagnostic and statistical manual of mental disorders. 2000. 4th ed. Washington, D.C.: American Psychiatric Association.
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LifeSpan Developmental Trauma
Play Therapy and Trauma
Title: Intensive short-term group play therapy. Author(s)/Editor(s): Tyndall-Lind, Ashley; Landreth, Garry L. Source/Citation: Innovations in play therapy: Issues, process, and special populations., Philadelphia, PA, US: Brunner-Routledge; 2001, (xii, 369), 203-215 Abstract/Review/Citation: In this chapter, Tyndall-Lind and Landreth argue that when a child has experienced a crisis or trauma, the play therapist should consider intensive play therapy in which the child is scheduled for play therapy sessions 2 or 3 times a week for the first 2 weeks in order to speed up the therapeutic process. Intensive play therapy is also recommended for a child who is already being seen in play therapy and has such an experience. The authors discuss the applications of group therapy in intensive play therapy, treatment format (i.e., group size, structure, and materials and techniques), and practical applications in intensive short-term group play therapy.
Title: Play therapy behaviors of sexually abused children. Author(s)/Editor(s): Ater, Meredith K. Source/Citation: Innovations in play therapy: Issues, process, and special populations., Philadelphia, PA, US: Brunner-Routledge; 2001, (xii, 369), 119-129 Abstract/Review/Citation: This chapter notes that there are several properties of play which allow sexually abused children a sense of safety and distance while working through their trauma. Play can be symbolic in that a child can use a toy to represent the sexual abuser. Play can be "as-if" in that child can act out events "for pretend." Play can be projection in that child can put emotion onto toys or puppets that can safely act out their feelings. Play can be displacement in that the child can give their negative feelings to dolls or toys, instead of their own family members. Children may express themselves in a multitude of ways in the playroom: abreactive, aggressive, nurturing, perseveration, regressive, or sexualized play. Sand/water play and doll/puppet play seem to be especially therapeutic for the healing process in the playroom. Children may also use drawings to give the therapist information about their sense of self, the traumatic events, the abuser, or any support they have received. from the family.
Title: Short-term play therapy. Author(s)/Editor(s): Johnson, Shaunda Peterson Source/Citation: Innovations in play therapy: Issues, process, and special populations., Philadelphia, PA, US: Brunner-Routledge; 2001, (xii, 369), 217-235 Abstract/Review/Citation: Within the context of this chapter, short-term play therapy is defined by 12 or less play therapy sessions. This chapter presents case reports and research studies documenting the effectiveness of short-term therapy with children, including individual play therapy, group play therapy, and filial therapy as useful interventions with children with a wide range of difficulties. These difficulties include abuse and neglect, aggression and acting out, emotional disturbances and schizophrenia, encopretic problems, fear and anxiety, grief, hearing impairment with behavioral difficulties, reading difficulties, social adjustment problems, speech difficulties, trauma, and withdrawal.
Title: Play therapy with traumatized children: A crisis response. Author(s)/Editor(s): Webb, Pamela Source/Citation: Innovations in play therapy: Issues, process, and special populations., Philadelphia, PA, US: Brunner-Routledge; 2001, (xii, 369), 289-302 Abstract/Review/Citation: On the basis of years of observation, L. C. Terr ( 1991-15338-001) identified 4 characteristics that children exhibit following exposure to a traumatic event: (1) recurrent and intrusive, distressing visual recollections of the event; (2) repetitive behaviors, such as repeated reenactment of the distressing episode during play or through behavioral idiosyncrasies; (3) trauma-specific fears; and (4) changed attitudes about people, aspects of life, and the future. This chapter begins by discussing the mediating variables of children's reactions to trauma and the melding principles of play therapy with crisis response. The author then describes her experience as a play therapist assisting the survivors of the 1995 bombing of a federal office building in Oklahoma City. She also describes her work as a school counselor offering grief counseling to students following the death of a popular middle school teacher.
Title: A creative play therapy approach to the group treatment of young sexually abused children. Author(s)/Editor(s): Gallo-Lopez, Loretta Source/Citation: Short-term play therapy for children., New York, NY, US: The Guilford Press; 2000, (xiv, 384), 269-295 Abstract/Review/Citation: Presents a comprehensive, time-limited group treatment program for sexually abused children (aged 3-10 yrs). The program attempts to combine the essential elements of therapy with sexually abused children into a treatment protocol that appears to be well-suited for this population. It offers a time-limited approach that directly addresses symptoms of trauma, developmental issues, and the impact of sexual abuse on interpersonal relationships. Though much of the program is directive and abuse-specific, it relies on the healing power of child-centered, nondirective play therapy to enhance the potential for growth and change. The author aims to provide the reader with a framework of healing opportunities to meet the complex needs of the young sexually abused child.
Title: The art of psychotherapy: Case studies from the Family Therapy Networker. Author(s)/Editor(s): Simon, Richard; Markowitz, Laura; Barrilleaux, Cindy; Topping, Brett Source/Citation: New York, NY, US: John Wiley & Sons, Inc; 1999, (xx, 315) Abstract/Review/Citation: Drawing together 2 decades of the Family Therapy Networker's popular case studies and commentaries, this book illustrates the art of psychotherapy as practiced by authorities on couples and family therapy. In addition to the full text of the cases, this book also offers commentaries and study questions to stimulate thought and discussion, making this text a good teaching tool. Organized by treatment population to make it easy to reference, the cases explore couples issues, working with children, and the unique challenges of therapy in the 1990s. Notes/Comments: Interracial couples: "What textbooks don't tell you--Acknowledging the complexities of real-life therapy"Kenneth Hardy Multicrisis couples: 'Becoming an emotional conduit'Maya Kollman After the affair: "Turning down the temperature--Handling one of marriages most explosive crises" Leo Fay Short-term techniques: "Briefer and deeper--Addressing the unconscious in short-term treatment" Bruce Ecker and Laurel Hulley Treating the ongoing affair: "Hot chat--Virtual affairs can become very real emotionally" Linda S. Freedman Working with children Boundaries: "Leaving the mothering to Mother--Helping a parent become accountable" Nina Shandler How to diagnose: 'Treating ADHD--Understanding attentional deficits can sharpen our treatment strategies" Susan Bogas Gender identity issues: "The boy who loved Catwoman--Deciding who has the problem in a case that challenges gender norms" Edited by H. Charles Fishman Adoption: "Adrian's choice--Helping a young adoptee decide where he belongs" Ton C. Smets Countertransference: "Joining the family--Countertransference can be the therapist's compass" David E. Scharff and Jill Savege Scharff Adolescents: "Nunna yer beeswax--No-talk therapy with adolescents" Martha B. Straus Psychotherapy and modern life Crosscultural issues: "No time to waste--When culture and medical needs conflict" Edited by H. Charles Fishman Homosexuality: "Quandaries of a heterosexual therapist--When should sexual orientation be the focus of treatment?" Edited by H. Charles Fishman Multiproblem families: "Lost in America--Overcoming the isolation of a multiproblem, middle-class family" Judith Friedman and Ella Lasky Recovered memories: "Avoiding the truth trap--Responding to allegations (and denials) of sexual abuse" Henry SchisslerRecovered memories: "Resolving the irresolvable--Constructing a way out for families torn apart by struggles over recovered memories" Mary Jo Barrett The tools of the trade Alternatives to solution-focused therapy: "Mr. Spock goes to therapy--Good therapy means knowing when to break the rules" Eve Lipchik Play therapy: "The gift of play--Using improvisation in the therapy room" Daniel J. Wiener Network interventions: "Humanizing the impossible case--Engaging the power of a family-larger systems intervention" Jay Lappin and John VanDeusen Eye movement desensitization: "The enigma of EMDR--An intriguing new treatment method promises dramatic results" Clifford Levin Thought field therapy: "A no-talk cure for trauma--Thought field therapy seems to violate all the rules" Fred Gallo The impossible case Court-mandated cases: "The resistant substance abuser--court-mandated cases pose special problems" Edited by H. Charles Fishman Clients and self-help: "The overresponsibility trap--helping codependents create a new life story" Joseph Eron and Thomas Lund Collaborative treatment: "Is the customer always right?--Maybe not, but it's a good place to start" Barry L. Duncan, Scott D. Miller and Mark A. Hubble Difficult cases: "One step forward, two steps back--Treating the unmotivated client" Edited by H. Charles Fishman Deinstitutionalization: "Herman wept--Or, the battle of narratives" Michael J. Murphy couples & family & child & adolescent psychotherapy & issues related to modern psychotherapy & psychotherapeutic techniques, case studies.
Title: Play therapy crisis intervention with children. Author(s)/Editor(s): Webb, Nancy Boyd Source/Citation: Play therapy with children in crisis: Individual, group, and family treatment (2nd ed.)., New York, NY, US: The Guilford Press; 1999, (xxi, 506), 39-46 Abstract/Review/Citation: The primary purpose of play therapy is to help troubled children express their conflicts and anxieties through the medium of play in the context of a therapeutic relationship. The therapist's conscious direction of the child's play activity gives it purpose, meaning, and value in treatment. This chapter focuses on the special play therapy approaches that deal with children in situations of crisis and trauma. Topics addressed in the chapter include range of play therapy methods (art techniques, doll play, puppet play, storytelling, board games, other assorted play therapy techniques), role of the play therapist, training in child therapy, group and family play therapy, parent counseling, and versatile application of play therapy.
Title: Case study using Adlerian play therapy. Author(s)/Editor(s): Snow, Marilyn S.; Buckley, Matthew R.; Williams, Sylvia C. Source/Citation: Journal of Individual Psychology: Special Issue: Play therapy and individual psychology.; Vol 55(3) Fal 1999, US: Univ of Texas Press; 1999, 328-341 Abstract/Review/Citation: Play therapy provides children from chaotic, traumatic, and abusive environments with the opportunity to communicate, through play, their perceptions of themselves, others, and their world. Incorporating the principles of individual psychology, Adlerian play therapy offers therapists a framework for working with children within the social context of family and school. The authors discuss consultations with the school, an overview of the family constellation, and an analysis of the phases of Adlerian play therapy using a case study of a preadolescent boy experiencing trauma and disorientation in his home environment and problems at school.
Title: Play therapy for children exposed to violence: Individual, family, and community interventions. Author(s)/Editor(s): VanFleet, Rise; Lilly, John Paul; Kaduson, Heidi Source/Citation: International Journal of Play Therapy; Vol 8(1) 1999, US: The Assn for Play Therapy; 1999, 27-42 Abstract/Review/Citation: Outlines play therapy-related interventions that have been used to assist children who have been exposed to violence and are at risk for developing posttraumatic stress disorder (PTSD). Play therapy approaches for children exposed to violence, family play therapy for families affected by violent trauma, and a description of a community intervention that works with play therapists to ensure that children and families are empowered and supported following violence and abuse are included.
Title: Sandrama: Psychodramatic sandtray with a trauma survivor. Author(s)/Editor(s): Toscani, Francesca Source/Citation: Arts in Psychotherapy; Vol 25(1) 1998, US: Pergamon c/o Elsevier Science Inc; 1998, 21-29 Abstract/Review/Citation: Describes the use of psychodramatic techniques in sandtray therapy (Sandrama) with a 37-yr-old woman with a history of severe emotional, physical, and sexual abuse in childhood and adolescence. The author used Sandrama as a tool in an individual session with the S and provided clinical considerations necessary for safety by using the Therapeutic Spiral Model, a manualized format for the safe use of action methods with trauma survivors, as a theoretical basis. Sandrama allowed the S to play all the roles by manipulating objects rather than physically role-reversing and marking each role with an object; Sandrama also more easily allowed for a psychodrama in individual sessions. The Sandtray also provided more distance and objectivity by affording an additional safe container; by being outside the sandbox, the S is in a "mirror position" and can view the action taking place. Sandrama provided the S with a safe environment to release and express her rage about a specific traumatic event and to begin to move forward in therapy.
Title: Rubble, disruption, and tears: Helping young survivors of natural disaster. Author(s)/Editor(s): Shelby, Janine S. Source/Citation: The playing cure: Individualized play therapy for specific childhood problems., Northvale, NJ, US: Jason Aronson, Inc; 1997, (xiii, 383), 143-169 Child therapy series. Abstract/Review/Citation: this chapter aims to help prepare play therapists to work with the youngest survivors of natural disasters / describes how children use play to move from crisis to confidence as they learn to manage their distress / share the author's experiences as a disaster mental health provider and researcher, highlighting the lessons that children themselves have taught the author about how they need to heal / discuss crisis intervention play therapy for children with posttraumatic stress disorder (PTSD) or acute stress disorder
Title: Play therapy with sexually abused children. Author(s)/Editor(s): Hall, Pamela E. Source/Citation: The playing cure: Individualized play therapy for specific childhood problems., Northvale, NJ, US: Jason Aronson, Inc; 1997, (xiii, 383), 171-194 Child therapy series. Abstract/Review/Citation: describes the detailed and intricate therapist-client interplay required when working with early school-age children who have been sexually abused / play therapy is a curative method by which to address the traumatized child / the decision to use play therapy techniques and employ C. E. Schaefer's (1993) 14 therapeutic factors of play will ensure that the major issues regarding the processing of trauma are addressed / presents the case illustration of a 6-yr-old girl
Title: The game's the thing: Play psychotherapy with a traumatized young adolescent boy. Author(s)/Editor(s): Weine, Steven M. Source/Citation: Adolescent psychiatry, Vol. 21: Developmental and clinical studies., Hillsdale, NJ, US: The Analytic Press, Inc; 1997, (xv, 505), 361-386 Annals of the Amerian Society for Adolescent Psychiatry. Abstract/Review/Citation: The author uses a case of a traumatized early adolescent boy whom he treated with psychotherapy to illustrate some particular ways in which play psychotherapy may be used in the treatment of a traumatized individual. The treatment he devised for this adolescent uses both traditional and novel play psychotherapeutic approaches. Competitive athletic games are used as the major psychotherapeutic activity. The case discussion (aspects of play in competitive athletic games, therapeutic functions of play and the dilemmas of the therapist) focuses on the trauma as the predominant etiological contributant to the patient's difficulties.
Title: 101 favorite play therapy techniques. Author(s)/Editor(s): Kaduson, Heidi G.; Schaefer, Charles E. Source/Citation: Northvale, NJ, US: Jason Aronson, Inc; 1997, (xvi, 401) Child Therapy Series. Abstract/Review/Citation: Building on children's natural inclinations to pretend and re-enact, play therapy is widely used in the treatment of psychological problems in childhood. This book incorporates methods developed to elicit the best responses from children by therapists representing cognitive-behavioral, psychodynamic, and other orientations, and selected for their practicality, specificity, and originality. Arranged for easy reference, each bearing a succinct description and targeted application, the interventions illustrated--including fantasy, storytelling, expressive arts, game play, puppet play, play toys and objects, and group play--have been used with success to address such common problems as low self-esteem and unresolved fear and anger as well as more serious difficulties arising from loss, abuse, and sexual trauma. Notes/Comments: Preface Section one: Fantasy techniques The playing baby game Charles E. Schaefer Using guided imagery to augment the play therapy process Kevin O'Connor The rosebush Violet Oaklander Pretending to know how S. Eileen Theiss Section two: Storytelling techniques The feeling word game Heidi Gerard Kaduson The card story game Norma Y. Leben Storytelling with felts Linda Mattingly The box of buttons technique Jo Ann L. Cook Computer storytelling N. E. Brewer Using metaphors, fairy tales and storytelling in psychotherapy with children Jamshid A. Marvasti Art or verbal metaphors for children experiencing loss Glenda F. Short The guess my word story game Mary Repp The scarf story Steve Harvey Storytelling with objects Jackie K. Frederiksen Section three: Expressive arts techniques The before and after drawing technique Donna Cangelosi Feeling balloons Glenda F. Short Magic art Ruby Walker The yarn drawing game Norma Y. Leben Clayscapes Lynn B. Hadley Bad dreams L. G. Agre The personality pie Tara M. Sinclair Life maps Glenda F. Short Play art Lynn B. Hadley Gloop: Treating sensory deprivation Neil Cabe The clay squiggle technique Richard Frankel Expressive arts playdough Lynn B. Hadley Inner-reference Aimee H. Short Reworking Sheri Saxe A line down the middle of the page Dolores M. Conyers Create-a-community Nancy H. Cochran Outline drawings of boys and girls Barbara A. Turner The picture drawing game Stanley Kissel The color-emotive brain Sheldon Berger and Jonna L. Tyler Scribble art Leslie Hartley Lowe The feelings tree Joyce Meagher Design-a-Dad Stazan K. Sina Synthetic clay in play therapy Martha D. Young Section four: Game play techniques Checkers: Rules or no rules L. G. Agre Beat the clock Heidi Gerard Kaduson Pounding away bad feelings Donna Cangelosi The pick-up-sticks game Barbara McDowell The stealing game Steve Harvey Consequences: Reaching the oppositional defiant adolescent Neil Cabe Hide-and-seek in play therapy John Allan and Mary Anne Pare The spy and the sneak Bria Bartlett-Simpson Pool play: Helping children get out from behind the eight ball Stanley Kissel Tumbling feelings: Easing children into the counseling relationship Christina Mattise Make your own board game Sandy Carter Chess playing as a metaphor for life choices Leslie Hartley Lowe Section five: Puppet play techniques Battaro and the puppet house Martha J. Harkin The dowel finger puppet technique Jo Ann L. Cook Create-a-puppet Anne Blackwell Using a puppet to create a symbolic client Carolyn J. Narcavage Puppetry Marie Boultinghouse On the one hand . . .and then on the other Christina Mattise Section Six: Play toys and objects techniques Bodysox Kimberly Dye The me doll Jessica Stone-Phennicie Tearing paper Kathy Daves The mad game Patricia Davidson Sculpt-it Michael Cascio The magic carpet technique Dolores M. Conyers The snake Alan Lobaugh The baby bottle technique Diane Murray The T-shirt technique Nancy H. Cochran The photo album technique Sueanne Brown The angry tower Sheri Saxe Balloons of anger Tammy Horn The worry can technique Debbie S. Jones The cardboard city Berrell Mallery and Randall Martin Fortune tellers Judith Friedman Babcock Jenga and a camera Catherine G. Tierney The anger shield Teresa A. Glatthorn Using self-made books to prepare children for predictable trauma or crisis Kevin O'Connor The angry feeling scale game Joyce Meagher Stomping feet and bubble popping Cathy Wunderlich Knocking down the walls of anger Jennifer Leonetti Figures Sylvia Fisher Section Seven: Group play techniques Elastablast Kimberly Dye Group building activity Glenda F. Short The captains of Avatar: A space adventure for children in transition Tara M. Sinclair Mr. Ugly Mary May Schmidt Therapeutic puppet group Aileen Cunliffe Group puppet show Glenda F. Short Mutual storytelling through puppet play in group play therapy Mitch Jacobs Section eight: Other techniques Using drawings of early recollections to facilitate life style analysis for children in play therapy Harold M. Heidt Self figures for sand tray L. Jean Ley and Jean Howze The worry list Richard Sloves My baby book Karen Pitzen The song flute or recorder Robert W. Freeman The starting over wedding gown ceremony Patricia B. Grigoryev Play therapy and pets Mary-Lynn Harrison The twelve-to-one technique Mary May Schmidt The therapist on the inside Patricia B. Grigoryev Play-by-play David A. Snyder The time line tape technique Jo Ann L. Cook Terminations utilizing metaphor CONTENTS TRUNCATED description & application of play therapy techniques in treatment of psychological problems in childhood
Title: Free symbolic play and assessment of the nature of child sexual abuse. Author(s)/Editor(s): Wershba-Gershon, Pamela Source/Citation: Journal of Child Sexual Abuse; Vol 5(2) 1996, US: Haworth Press Inc; 1996, 37-58 Abstract/Review/Citation: Discusses the value of free symbolic play to the field of sexual abuse. The following 2 points are presented: (1) free symbolic play is a modality well suited to the expression, reworking and mastery of psychic trauma and therefore offers sexually abused children a channel for communication, and (2) free symbolic play is a potential source of information to mental health professionals when attempting to understand the context of a child's experience of sexual abuse. Preliminary guidelines are suggested regarding the appropriate use of free symbolic play to gain information about possible sexual abuse. A case study of a 7-yr-old girl that illustrates the application of free symbolic play to evaluation and treatment of sexual abuse is presented. The potential impact of research comparing the free symbolic play of sexually abused and nonabused children is considered.
Title: Play therapy: The patterns and processes of change in maltreated children. Author(s)/Editor(s): Mills, Barbara Cranston Source/Citation: Dissertation Abstracts International Section A: Humanities & Social Sciences; Vol 57(3-A) Sep 1996, US: University Microfilms International; 1996, 1034 Abstract/Review/Citation: This qualitative case study research chronicles the process of change during play therapy of two children who experienced maternal loss and maltreatment during the first two years of life. At the outset of this study both children presented with evidence of insecure attachment as well as symptoms and behaviour consistent with maltreatment. Over the course of a year of therapy, both demonstrated profound change and healing. The study concludes that the children were able to utilize the safety, consistency, and affirmation of the therapeutic relationship to discard old models of relating, and to construct new internal representational models of self and of self in relation to others. Once old models were discarded, the children returned to the earliest stage of damage and reworked attachment salient developmental tasks while in relation with the therapist. The projective materials of the play therapy space provided the medium through which the children externalized selected trauma and critical incidents that shaped their maladaptive models. As the therapist gave voice to the previously unacknowledged experiences, the child's authentic self was able to disentangle from the trauma. The pattern by which the self emerged and developed over the course of therapy approximated developmental pathways described by prominent self theorists (Bretherton & Beeghly, 1982; Mahler et. al, 1975; Stern, 1985). Change was exhibited in the classroom approximately 10 to 14 weeks after the children were initially seen in therapy.
Title: The use of dramatherapy and play therapy to help de-brief children after the trauma of sexual abuse. Author(s)/Editor(s): Cattanach, Ann Source/Citation: Dramatic approaches to brief therapy., Bristol, PA, US: Jessica Kingsley Publishers, Ltd; 1996, (273), 177-187 Abstract/Review/Citation: describes a method of brief intervention with young children who have experienced a traumatic sexual assault / there is an initial intervention which is a de-briefing of the event and this is followed with further meetings to help the child contextualize the assault and help prevent post-traumatic stress / dramatherapy and play therapy processes are used to facilitate de-briefing and help cope with the incident
Title: Enactment and play following medical trauma: An analytic case study. Author(s)/Editor(s): Goldberger, Marianne Source/Citation: Psychoanalytic Study of the Child; Vol 50 1995, US: Yale Univ. Press; 1995, 252-271 Abstract/Review/Citation: This paper on the four-year analysis of a five-year-old girl with a school phobia details the playroom enactments of medical trauma and its sequelae. Early in the analysis the patient expressed herself almost exclusively through play. Gradually she connected her conflicts, including those over her compulsive masturbation, to her hospital experiences. Only after the traumatic medical experiences were no longer the after the traumatic medical experiences were no longer the major issue did other important conflicts become available for analytic work. Physical activity remained prominent in the analysis and generated pressure for mutual enactment. This case again draws our attention to the complex overlap of lay, enactments, and verbalization in child analysis.
Title: Handbook of play therapy, Vol. 2: Advances and innovations. Author(s)/Editor(s): O'Connor, Kevin J.; Schaefer, Charles E. Source/Citation: New York, NY: John Wiley & Sons; 1994, (xiv, 447) Wiley series on personality processes. Abstract/Review/Citation: "The Handbook of Play Therapy, Volume Two: Advances and Innovations" considerably expands on the first volume [published in 1983] by presenting the theoretical, technical, and methodological advances coming out of this steadily growing field. Leading authorities on the various aspects of play therapy [were invited] to write original chapters presenting the developments that have occurred in the field since 1983. Material [included] is interdisciplinary in approach, eclectic in theory, and comprehensive in scope. Psychiatrists, psychologists, social workers, nurses, and counselors at all levels of training and experience will find this [handbook] informative, thought provoking, and clinically useful. Notes/Comments: Part 1: Theoretical approaches to the practice of play therapy Adlerian play therapy Terry Kottman Time-limited play therapy Richard E. Sloves and Karen Belinger Peterlin Ecosystemic play therapy Kevin J. O'Connor Dynamic play therapy: Expressive play intervention with families Steven Harvey Cognitive-behavioral play therapy Susan M. Knell Gestalt play therapy Violet Oaklander Part 2: Developmental adaptations of play therapy Adolescent theraplay Terrence J. Koller The use of play therapy with adults Diane E. Frey Geriatric theraplay Sandra Lindaman and Debra Haldeman Part 3: Play therapy techniques and methods The Erica Method of sand play diagnosis and assessment Margareta Sjolund and Charles E. Schaefer Jungian play therapy techniques Gisela De Domenico The Good Feeling-Bad Feeling Game Sue Ammen Part 4: Play therapy applications Play therapy for psychic trauma in children Charles E. Schaefer Play diagnosis and play therapy with child victims of incest Jamshid A. Marvasti Play therapy with mentally retarded clients Joop Hellendoorn Filial therapy for adoptive children and parents Rise Van Fleet Play therapy with children of alcoholics and addicts Mary Hammond-Newman A structured activities group for sexually abused children Scott J. Van de Putte Author index Subject index theoretical approaches to & techniques & methods & applications of play therapy, children, handbook
Title: Play therapy for psychic trauma in children. Author(s)/Editor(s): Schaefer, Charles E. Source/Citation: Handbook of play therapy, Vol. 2: Advances and innovations., New York, NY: John Wiley & Sons; 1994, (xiv, 447), 297-318 Wiley series on personality processes. Abstract/Review/Citation: examine childhood trauma resulting from isolated incidents as opposed to trauma related to chronic situations / common childhood reactions to disaster, spontaneous posttraumatic play, play therapy interventions, and clinical issues related to the treatment of traumatized children will all be addressed / risk factors for childhood trauma reactions / assessment of childhood trauma reactions / curative powers of abreactive play / self initiated abreactive play / retraumatizing play / play disruption / dissociation / procedure [historical roots of mastery play therapy, release therapy, trends in mastery play therapy]
Title: The therapeutic use of play in the treatment of patients with multiple personality disorder. Author(s)/Editor(s): Olson, Jean A. Source/Citation: Expressive and functional therapies in the treatment of multiple personality disorder., Springfield, US, US: Charles C Thomas, Publisher; 1993, (xix, 312), 201-217 Abstract/Review/Citation: any therapist who works with patients who have multiple personality disorder (MPD) will at some point encounter child alters or fragments within the patient's system / what should a therapist do when faced with the representation of a toddler, pre-schooler, or young school-age child in an adult body / how should a therapist respond to the fairly common injunction by the child alters themselves or by others within the system that "the kids need to play" / [discusses] application of play and play therapy techniques . . . in the treatment of selected MPD patients / in order to be most effective, play should be employed only when there are specific goals that may best be achieved with these methods [developing trust and rapport, facilitating communication and uncovering trauma, reducing stress and channeling energy, promoting cognitive and emotional development, reducing interference with therapeutic work, providing normal developmental experiences, reenacting and abreacting trauma]
Title: The use of the dollhouse as an effective disclosure technique. Author(s)/Editor(s): Klem, Patricia R. Source/Citation: International Journal of Play Therapy; Vol 1(1) 1992, US: The Assn for Play Therapy; 1992, 69-73 Abstract/Review/Citation: Presents an overview of use of the dollhouse to facilitate disclosure. The patient was a 6 yr old albino male, diagnosed as developmentally delayed who suffered physical abuse from his father and an older brother. The goal of the therapy was to assist the child in the processing and healing of his trauma. During 4 sessions the child was able to disclose his trauma and produce solutions with the aid of the therapist and dollhouse. The child's choice of metaphor, the dollhouse, assisted him in overcoming to a degree, the sense of helplessness and isolation he felt during the abuse.
Title: Tears into diamonds: Transformation of child psychic trauma through sandplay and storytelling. Author(s)/Editor(s): Miller, Carol; Boe, John Source/Citation: Arts in Psychotherapy; Vol 17(3) Fal 1990, US: Pergamon c/o Elsevier Science Inc; 1990, 247-257 Abstract/Review/Citation: Describes a treatment program to deal with child psychic trauma. The program uses sandplay and storytelling to help patients communicate on a deep level through metaphors. In the program, an average census of 14 children (aged 4-12 yrs) were read fairy tales, and children's stories were matched to the children's sandtray and/or history. This gives a name to the child's worst fears and a framework to conquer those fears. Case studies of 2 physically and sexually abused girls (aged 8 yrs and 10 yrs) show how sandplay helped the Ss to express their trauma at a safe distance. Anecdotal evidence of the use of storytelling shows how the staff can respond in the metaphor. This cross-modal matching of metaphor to metaphor is compared to R. A. Gardner's (1971) mutual storytelling technique.
Title: Play therapy with children who have experienced sexual assault. Author(s)/Editor(s): Walker, Lenore E. Auerbach; Bolkovatz, Mary Ann Source/Citation: Handbook on sexual abuse of children: Assessment and treatment issues., New York, NY, US: Springer Publishing Co, Inc; 1988, (xxix, 448), 249-269 Abstract/Review/Citation: the use of play materials to either simulate presentation of, focus on, or work through certain problems has been used successfully by the authors to help heal sexually abused children / philosophy and goals of play therapy with the sexually abused child / to reduce the present and future negative psychological impact on the child arising from the trauma of sexual abuse / providing a place to heal from the shock of the abuse and the emotional aftermath of discovery / play therapy issues / fear and lack of trust / mastery and desensitization to abuse / emotional pseudo-independence / precociousness and seductiveness / protection of self and others / shame and self-balance / confrontation with anger / process of play therapy / understanding children's repetitive play rituals
Title: Imaginative play technique in psychotherapy with children. Author(s)/Editor(s): Hellendoorn, Joop Source/Citation: Innovative interventions in child and adolescent therapy., New York, NY: John Wiley & Sons; 1988, (xvi, 448), 43-67 Wiley series on personality processes. Abstract/Review/Citation: play in child therapy / imaginative play is the essential therapeutic ingredient of imagery interaction, actively used by the therapist to bring about change / therapeutic practice will be described . . . with case illustrations / play therapy / research findings / imagery interaction play technique / action examples of play techniques are discussed / theme[s] . . . in play sessions / talking about problems in play / controlling the relationship / friend or foe / overcoming trauma in brief mother-child treatment / silent growing experience / grief work in play / play therapy with the mentally handicapped children / combining imaginative play therapy with behavior modification techniques
Title: Play-therapy of a posttraumatic aphasia. Author(s)/Editor(s): Wild-Missong, Agnes Source/Citation: Psychologie v Ekonomicke Praxi; Vol 29(1-2) 1970, Czechoslovakia: Charles University; 1970, 362-367 Abstract/Review/Citation: Presents a case study of a 3-yr-old aphasic boy demonstrating the multiple determination of the ability for linguistic expression. Both brain damage and traumatic experience were the causes of the aphasia. The course of the play-therapy demonstrated the connection between overcoming the psychic trauma and reacquisition of language: linguistic expression was completely blocked throughout the climax of the playing activity, followed by a sudden deblocking and precipitous reacquisition of spoken language. It is suggested that a reorganization in the brain processes parallels the psychological development. (French summary)
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