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VLE 3: Rebuilding Attachments with Military Children Utilizing Play Therapy

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Connecting military family service providers and Cooperative Extension professionals to research

and to each other through engaging online learning opportunities

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MFLN Intro

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James Corbin, MSW, LSW

•Doctoral candidate from the Clinical Social Work Institute in Washington, DC

•Licensed Social Worker in Pennsylvania with a specialty in childhood mental illness and individual and family therapy with children, adolescents, and their families

•Since 2008, has served as full-time clinical faculty and instructor in the Graduate School of Social Work at Temple University and is the Clinical Director and Lead Developer of the Family Center at Temple University Harrisburg

•Has written and presented extensively on the subject of neuroscience, trauma, and attachment and the impact on clinical practice and been a featured presenter for the National Association of Social Workers at their Annual Conference.

•Received training in child-centered play therapy and practiced as a child and family therapist for The Play Therapy Center and is a former associate with D.K. Watkins Psychology Associates in York, Pennsylvania.

Today’s Presenter

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Attachment, Play Therapy, and the Military ChildPresented for the Military Families Learning Network

CC0 Public Domain https://pixabay.com/en/soldier-daughter-child-looking-870387/

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Hall describes the Family Fortress and Characteristics: Secrecy Stoicism Denial(Hall, L.K. (2008). Counseling military families: What mental

health professionals need to know. Routledge, New York)

They are characteristics that are helpful to the warrior and their mission, but often complicate matters when problems arise.

Military family and children

CC0 Public Domainhttps://pixabay.com/en/soldier-america-independence-day-1385436/

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Type I – trauma from a discreet incident

Type II – occurs (often) in small increments and on more than one occasion Domestic Violence Alcoholism Military Relocation Multiple Deployments

Types of trauma military children may experience

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Family Support Networks – Family Readiness Groups (FRG)

Child and Family Services (various branches and National Guard)

Family Readiness System (the network of agencies, programs, services, and individuals, and the collaboration among them, that promotes the readiness and quality of life of service members and their families.) DoDI 1342.22 Military Family Readiness

Forms of support for children and families

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The Neurobiology of AttachmentTrauma and Healing

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Infant Research and Attachment

Bowlby (1960) in describing the primacy of early childhood attachments suggested that the biological motive for attachment was equal to that of the instinctual drives.

Childhood development: Theoretical constructs

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Image by James Corbin used by permission

Winnicott (1952) is well-known for his idea that “there is no such thing as a baby” in describing the primacy of the early mother-infant relationship and its role in the child’s developing object-relations.

Mother-infant attachment

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Image by James Corbin used by permission

Indeed, animal research as well as infant studies have confirmed that neuroanatomy, neurochemical events, and observable behaviors are all subsequently modified by early interactions with caregivers and that these internal processes are concurrently organized and affect each other (Schore, 1999; Beebe & Lachmann, 2002).

The critical role of attachment

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In the absence of appropriate dyadic attachment experiences during infancy, a child as they grow into adulthood may exhibit difficulties in their ability to self-soothe, self-organize, regulate affect, and engage in healthy relationships (Bowlby, 1969; Winnicott, 1959; Kradin, 2004).

Some problems associated with attachment

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It is generally agreed that attachment security protects against psychopathology (Fonagy, 2001). Attachment experiences include the complex physiological, biological, genetic, and behavioral facets of the early caregiving environment and concomitant interactive processes. Therefore it is no surprise that there exists clear evidence that neglect and attachment difficulties in early development may be even more damaging than abuse (Schore, 2003).

Problems with attachment, continued . . .

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Gross anatomy of the brain

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Focus on the BrainIts hemispheres and the effect of trauma on the brain, its structures, and their basic functions.

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The left hemisphere is largely involved in language, logical reasoning, the conscious, sequential, mathematical, storytelling, and verbal processes (Simpson, 2005a).

We know that this hemisphere is generally more pronounced in females than in males (Simpson, 2005c).

The left hemisphere

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Generally believed to involve the processes of the unconscious, emotion, spatial awareness, abstraction and is concerned with holistic process and the Gestalt (Simpson, 2005a).

Matures faster and is larger than the left hemisphere and is actually responsible for inducing the growth and development of the left hemisphere (Simpson, 2005a).

Generally considered dominant and is larger in males than females (Simpson, 2005c). We also know that similar damage to a particular hemisphere in male and female brains affects functioning in different ways between the genders (Ornstein, 1997).

The right hemisphere

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The hemispheres are joined together by a dense formation of connections called the corpus collosum (which means “big bundle”).

The corpus collosum is the brain’s “superhighway” and one of the main avenues for the hemispheres of the brain to communicate (Simpson, 2005a).

It was discovered that certain processes that are affected by trauma in one area of a hemisphere of the brain can be (on some level) taken over by a related structure in the opposite hemisphere (Gazzaniga, 1999).

The corpus collosum – the brain’s superhighway

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The amygdala is also a key structure in memory in that it creates the “emotional content” of memory and the feeling responses related to memory (Teicher, 2002).

The amygdala

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CCO Public Domain https://commons.wikimedia.org/wiki/File:Amygdala.jpg

This structure compares new experience with old memories and response; familiarity often evokes a predictable response comparable to novel experiences (Simpson, 2005d).

The hippocampus is an area of the brain that is affected by Alzheimer’s disease (Simpson, 2005a).

The hippocampus

CC0 via Public Domain https://en.wikipedia.org/wiki/Hippocampus#/media/File:Gray739-emphasizing-

hippocampus.png

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Liggan and Kay (1999) suggest that part of treatment for children with attachment difficulties, for instance, is focusing on the patterns and rules of implicit memory in an effort to help the child to reveal and reflect on them more fully.

They felt that what may be mutative in psychotherapy was that new patterns of relationships would be explicated, repeated, and learned so that these newly learned habits may be “engrained in the implicit memory system” (p. 105).

Role of therapy with children

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Play therapy and its benefitsMilitary children and application

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Play therapy can be defined in a general way as “an interpersonal process wherein a trained therapist systematically applies the curative powers of play to help clients resolve their psychological difficulties.” (Schaefer, 1993, p. 3)

Play therapy

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As Landreth so pointedly reminds us about children, “toys are their words” and play is their language (1993, p. 41).

For the child, play is the medium by which they can express their feelings and gain mastery over ideas, thoughts, and conflicts that may be reflected to the child as unacceptable in the adult world.

Play therapy

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Play therapy comes in many forms and lies along a continuum of activities from those techniques that are more directive and focused in scope to those that are quite ambiguous and non-directive.

Forms of play in therapy

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Play that facilitates talking “Fishing therapy” case “Puppet introduction”

case “The Ungame” Cards for teenagers Other therapeutic

games

Direct forms

CCO Public Domain https://en.wikipedia.org/wiki/Queen_(playing_card)#/media/File:Queen_playing_cards.jpg

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The use of play as a therapeutic technique is well-established and has been used by some of psychotherapy’s most prominent figures.

Play therapy – theoretical history

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Freud recognized the importance of play and wrote: “The opposite of play is not what is serious but what is real. In spite of all the emotion with which he cathects his world of play, the child distinguishes it quite well from reality.” (Freud, 1908, p. 143).

Sigmund Freud

29Papa Freud, conflicted, with cigar by Carla 216 CC via Flickr

Freud and many psychoanalysts recognized the value of play (1920) as did Erikson (Tyson, 1990) and Piaget.

Anna Freud and Burlingham used play in their work with orphans and small children in the Hampstead War Nurseries (A. Freud, 1942).

Mahler recognized play in the “practicing phase” of development as a means of solving problems and understanding the world around them (Mahler, et al., 1975).

Play therapy history

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Winnicott believes that play in of itself is “a therapy” and that a child’s play has “everything in it” (1971, p. 259)

Winnicott (1953) and Melanie Klein recognized its usefulness in their work with child and young adolescent clients.

Donald Woods Winnicott

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Winnicott (1971) describes the relationship of play to psychotherapy:

[I]t is play that is the universal, and that belongs to health: playing facilitates growth and therefore health; playing leads into group relationships; playing can be a form of communication in psychotherapy; and, lastly psychoanalysis has been developed as a highly

specialized form of playing in service of communication with oneself and others . . . (p. 257).

D.W. Winnicott, continued

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It also plays a crucial role in the integration of object-related wishes and fantasies as a means of problem-solving and reality testing.

Winnicott described how babies and children manipulate play objects in their environment to gain mastery over their growing object relationships.

D.W. Winnicott, continued

CC0 Public Domainhttps://pixabay.com/en/crayons-coloring-book-coloring-book-1445053/

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Winnicott continues, “If the patient cannot play, then something needs to be done to enable the patient to become able to play, after which psychotherapy may begin” (1971, p. 54).

D.W. Winnicott, continued

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The hopeful case of “Lava Boy”

Child-centered play therapy

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Carl Rogers (1951) first coined the term “client-centered therapy” and was highly influential in the development of the theoretical base and techniques of play therapy.

Carl Rogers

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One of Roger’s close colleagues, Virginia Axline (1947) collaborated with him on a number of occasions and is largely recognized as one of the founders of child-centered play therapy—a very special derivative of the client-centered approach used previously by Rogers with adult clients.

Virginia Axline

CC0 Public Domainhttps://pixabay.com/en/child-play-kindergarten-kita-1439032/

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Children communicate through play

Toys are children’s words, and play is their language ~G.Landreth

Child-centered play therapy

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Image by James Corbin used by permission

Play therapy

Axline (1950) summarized her concept of play therapy, “A play experience is therapeutic because it provides a secure relationship between the child and the adult, so that the child has the freedom and room to state himself in his own terms, exactly as he is at that moment in his own way and in his own time” (p. 68).

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CC0 Public Domainhttps://pixabay.com/en/boys-sitting-playing-toddlers-286784/

There are eight basic principles that guide the child-centered play therapy as described by Axline (1947). They are:

1) The therapist must develop a warm, friendly relationship with the child, in which good rapport is established as soon as possible.

2) The therapist accepts the child exactly as he is.

3) The therapist establishes a feeling of permissiveness in the relationship so that the child feels free to express his feelings completely.

4) The therapist is alert to recognize the feelings the child is expressing and reflects those feelings back to him in such a manner that he gains insight into his behavior.

The “ax”ioms of child-centered play therapy

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5) The therapist maintains a deep respect for the child’s ability to solve his own problems if given an opportunity to do so. The responsibility to make choices and to institute change is the child’s.

6) The therapist does not attempt to direct the child’s actions or conversation in any manner. The child leads the way; the therapist follows.

7) The therapist does not attempt to hurry the therapy along. It is a gradual process and is recognized as such by the therapist.

8) The therapist establishes only those limitations that are necessary to anchor the therapy to the world of reality and to make the child aware of his responsibility in the relationship. (pp. 73-74)

The “ax”ioms of child-centered play therapy, cont’d

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Child-centered play therapy involves free play with three types of equipment (Landreth, 1993).

1.Real-life toys include family dolls, doll houses, puppets, cars, trucks, a cash register, money, and other nondescript figures.

2.Play equipment may also include items that facilitate aggressive release such as bop bags, toy soldiers, animal figurines, guns, knives, and swords.

3.Equipment would also include items that facilitate creative and emotional expression including such things as crayons, paper, clay, sand and water, building blocks, an easel for drawing,and paint. (pp. 56-57).

Play therapy equipment

42Image by James Corbin used by permission

Hartley and his colleagues point to nine therapeutic benefits of play therapy (1952). Play gives children a chance to:

1) imitate various adults 2) play out real life roles in an intense way 3) reflect numerous relationships and experiences4) express immediate and pressing needs5) release unacceptable impulses and feelings 6) reverse roles usually taken in real life 7) mirror growth8) work out problems and conflict9) experiment with various solutions in a safe setting

Therapeutic benefits of play therapy

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Play therapy is well-documented in its effectiveness for children and early adolescents working through a variety of loss and grieving experiences including: Death Divorce Separation from care givers Trauma Neglect and abuse

Play therapy and grief work with children

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The case of “Rocket Girl and Interplanetary Mail Delivery”

The use of two playhouses and the blended family

Grief work and separation

CC0 Public Domain https://pixabay.com/en/heart-broken-patched-patch-symbol-48522/

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Association for Play Therapy: http://www.a4pt.org/

Temple University Certificate in Play Therapyhttp://www.temple.edu/harrisburg/Default.aspx?PageID=29

Articles/Books

V.M. Axline (1974). Play therapy. Ballantine Books: New York.

Bratton, S.C., Ray, D., Rhine, T., Jones, L. (Aug.,2005). The Efficacy of Play Therapy With Children: A Meta-Analytic Review of Treatment Outcomes. Professional Psychology: Research and Practice, Vol 36(4), pp. 376-390.

G.L. Landreth (2012). Play Therapy: The art of the relationship. Routledge: New York.

R.VanFleet. (1994). Filial therapy: Strengthening parent–child relationships through play. Practitioner's resource series. Sarasota, FL, US: Professional Resource Press/Professional Resource Exchange. xvi 69

C.E. Shaefer. (1994). Play therapy for psychic trauma in children (in Handbook of play therapy: Advances and innovations. Eds. C.E. Shaeffer, K.J. O’Connor). Wiley: Canada

Play therapy resources

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Neuroscience references and resources

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Amini, F., Lewis, T., Lannon, R., et. al. (1996). Affect, attachment, memory: Contributions toward psychobiological integration. Psychiatry, 59, 213-239.

Andreasen, N. (2001). Brave new brain: Conquering mental illness in the era of the genome. New York: Oxford University Press.

Baron-Cohen, S. (2003). The essential difference: The truth about the male and female brain. New York: Basic Books.

Beebe, B. & Lachmann, F. (2002). Infant research and adult treatment. London: Analytic Press.

Clark, J. (1989) (Ed.) The human body. New York: Arch Cape Press.

Damasio, A. (2003). Looking for Spinoza: Joy, sorrow, and the feeling brain. New York: Harcourt, Brace, and Company.

Damasio, A. (1999). The feeling of what happens: Body and emotions in the making of consciousness. New York: Harcourt, Brace, and Company.

Damasio, A. & Damasio, H. (1999). Brain and language. In the Scientific American: Book of the Brain (Editors of Scientific American). New York: The Lyons Press, pp. 29-42).

Edelman, G.M. (2004). Wider than the sky: The phenomenal gift of consciousness. New Haven: Yale University Press.

Fonagy, P. & Target, M. (1996). Playing with reality II: The development of psychic reality from a theoretical perspective. The International Journal of Psychoanalysis, 77:

Gabbard, G. (2000). A neurobiologically informed perspective on psychotherapy. British Journal of Psychiatry, 177, 117-122.

Gazzaniga, M. (1999). The split brain revisited. In the Scientific American Book of the Brain from (Eds.) from Scientific American, New York: The Lyons Press, pp. 129-138.

References and resources, continued

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Gruber, C. (2004, October 2). Cognition and Development. Lecture presented for The Clinical Social Work Institute, Washington, DC.

Hedaya, R. (1996). Understanding Biological Psychiatry. New York: W.W. Norton. Joseph, R. (1992). The limbic system: Emotion, laterality, and unconscious mind. Psychoanalytic Review,

79: 3, 405-455. Kandel, E.R. (1998). A new intellectual framework for psychiatry. American Journal of Psychiatry, 155, 457-

469. Liggan, D.Y., Kay, J. (1999). Some neurobiological aspects of psychotherapy: A review. Journal of

Psychotherapy Practice, 8(2), 103-114. McGuigan, F. (1994). Biological psychology: A cybernetic science. Englewood Cliffs, New Jersey: Prentice

Hall. Model, A. (2003). Imagination and meaningful brain. Cambridge, Massachusetts: A Bradford Book/The MIT

Press. Ornstein, R. (1997). The right mind: Making sense of the hemispheres. New York: Harcourt Brace and

Company. Ratey, J. (2001). A user’s guide to the brain: Perception, attention, and the four theaters of the brain. New

York: Pantheon Books. Schore, A. (1999). Affect regulation and the origin of the self. Mahwah: Lawrence Erlbaum.

Schore, A. (2003). Affect regulation and disorders of the self. New York: Norton. Siegel, D.J. (1999). The developing mind: Toward a neurobiology of interpersonal

experience. New York: The Guilford Press. Simpson, G. (2005a, September 23). Neuroscience. Lecture presented for The Clinical

Social Work Institute, Washington, DC. Simpson, G. (2005b, October 6). Neurotransmitters and the neural communication process.

Lecture presented for The Clinical Social Work Institute, Washington, DC. Simpson, G. (2005c, October 21). Sex differences in the brain. Lecture presented for The

Clinical Social Work Institute, Washington, DC. Simpson, G. (2005d, December 2). Memory, image, and representation. Lecture presented

for The Clinical Social Work Institute, Washington, DC. Solms, M. & Turnbull, O. (2002). The brain and the inner world: An introduction to the

neuroscience of subjective experience. New York: Other Press. Spitz, R.A., & Wolf, K.M. (1946). Anaclitic depression: An inquiry into the genesis of

psychiatric conditions in early childhood, II. Psychoanalytic Study of the Child, 2, 313-342. Stern, D. (1985). The interpersonal world of the infant: A view from psychoanalysis and

developmental psychology. New York: Basic Books. Stern, D. (2004). The present moment in psychotherapy and everyday life. New York: W.W.

Norton and Company.

References and resources, continued

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Stolorow, R.D. & Atwood, G.E. (1992). Context of being: The intersubjective foundation of psychological life. Hillsdale, NJ: The Analytic Press.

Teicher, M.H. (2002). Scars that won’t heal: The neurobiology of child abuse. Scientific American, 286(3), 68-75.

Thompson, R. F. (2005). Memory: The key to consciousness. Washington, DC: Joseph Henry Press.

Trevarthen, C. (1990). Brain circuits and functions of the mind. Cambridge: Cambridge University Press.

Trevarthen, C. (1998). The concept and foundations of infant intersubjectivity. In Braton, S. et, al. (Eds.) Intersubjective Communication and Emotion in Early Ontogeny: Studies in Emotion and Social Interaction. Cambridge: Cambridge University Press.

Tyson, P.T. (2002). The challenges of psychoanalytic developmental theory. Journal of the American Psychoanalytic Association, 50(1), 19-52.

Van der Kolk, B. (2003). Posttraumatic Stress Disorder and the nature of trauma: In Marion, Solomon, & Daniel Siegel (Eds.). Healing trauma: Attachment, mind, body, and brain. pp. 168-195. New York: W.W. Norton and Company.

Winnicott, D.W. (1959). The fate of the transitional object. In Psychoanalytic Explorations. Cambridge, MA: Harvard University Press.

References and resources, continued

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http://www.neuroguide.com/ - ground zero for any search on the internet involving the brain or neuroscience – should be one of your first stops

http://msnbc.msn.com/id/14309026/from/ET/ - contained in this article about the placebo effect is a terrific interactive demonstration about the brain

http://www.msnbc.msn.com/id/15310599/wid/11915773?GT1=8717 – this interactive site includes a interactive program that demonstrates the effect of various illegal drugs on the brain and body

http://www.brainconnection.com/ - a terrific interactive resource for education about the brain and various conditions of the brain salient to clinicians and educators – includes brain games and neuroscience in the news as well as links to numerous resources

http://quest.arc.nasa.gov/neuron/ - this site and on-line neurolab discusses the latest NASA mission and their project NeurOn that explores the effect of gravity on the nervous system – a fun site for children and educators

http://thalamus.wustl.edu/course/ - an on-line tutorial on brain and neuroscience basics sponsored by the Washington University School of Medicine – a highly educational and informative site for human service professionals

http://www.sfn.org/ - official site for the Society for Neuroscience – includes information about upcoming conferences in neuroscience, information about grants and news related to professional development

On-line resources about the brain

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CE Credit Information

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• For this webinar, we are offering Early Intervention, NASW, and Georgia Marriage and Family Therapy CE credits.

• Early Intervention CE credits are available to participants in Illinois, Georgia, Kansas, Kentucky, Ohio (EISC & EI CE credit), North Carolina, Tennessee, Texas, and Virginia.

• Webinar participants who want to receive a certificate of continuing education (or just want proof of participation in the training) need to take this evaluation and post-test: https://vte.co1.qualtrics.com/SE/?SID=SV_cGafMC3VpHHTyYd

• You must submit your certificate of completion and any other materials required to your state/agency in order to receive credit.

• CE certificates of completion will be automatically emailed to participants upon completion of the evaluation & post-test.

o Questions/concerns regarding EI CE credit certificates? Contact MFLNFDEarlyIntervention@gmail.com

o Questions/concerns regarding NASW CE credit certificatesContact MFLNFamilyDevelopment@gmail.com

Family Development Upcoming Event

VLE 4: Exploring the Impact of Moral Injury on Military Families

• Date: Thursday September 22nd• Time: 11:00am-12:30pm Eastern• Location: https://learn.extension.org/events/2653

For more information on MFLN Family Development go to: https://blogs.extension.org/militaryfamilies/family-development/

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