Does technology have a place in a play therapy session? With a little innovation and thinking outside of the box, technology can be used to reach resistant clients. Resistance occurs when further exploration into play themes or material becomes too threatening or intense, which can be frightening for children. I use a non-directive, child-centred expressive play therapy approach guided by the principles of Adlerian psychology and fully believe in the body’s innate wisdom to move toward healing, but what does one do when the client gets stuck in such a way? When a client of mine reached this plateau, I discovered that technology could provide an avenue for her move on and continue her healing.

Jessica* is an eight-year-old girl who had been adopted from Romania at one year of age. She had experienced several interruptions in her bonding experience during this first year and was showing me, through her play, the chaos of her early life. From the behaviours she displayed (tantrums, the need for control, the inability to accept any praise or encouragement, poor performance at school in spite of her above-average intelligence, a lack of friends, difficulty with transitions, odd eating behaviours, using negative language when referring to herself and overall poor self-image), I knew that I was seeing a child with attachment issues (Perry, 2001). This was affirmed by her parents’ statements that Jessica was always pushing them away, either with her negative behaviour or with her language. Jessica’s parents felt that they always had to be engaged with her, because as far as Jessica was concerned they could never spend enough time with her.

After nine months of weekly appointments, a few, small, positive changes in Jessica’s behaviours outside of the playroom were reported. She had begun to have some positive interactions with the children at the daycare she attended and was using her words more to express herself instead of getting angry and physical. She was interested in partaking in activities that she had resisted before.

In the playroom, Jessica always wanted to engage me in parallel play. She directed what I did as she self-directed her own play. On occasion she would ask that we trade places. Parallel play indicated there was wounding from her pre-adoption experience (Perry 2012). This, as well as other reported and observed behaviours, placed Jessica at a young age, far below her chronological age of eight (Perry, 2009). According to Dr. Perry’s (2009) neurodevelopment theory, the brain has four distinct regions: the brainstem, diencephalon, limbic system and cortex. The brain develops sequentially from the bottom up and the normal development of the brain is dependent on the normal development of the previous part of the brain. Each of the brain’s four regions has a function and each has its own timetable for development. This is significant as we can use a child’s behaviour to help us identify their developmental age.

This theory and the work of Daniel Hughes (2006) informed my next step: Jessica needed to have experiences that allowed her to develop in the areas where development had been disrupted. She also needed to be able to begin to make sense of her pre-adoption experiences. The goal, in collaboration with her parents, was to begin to put the negative pre-adoption experiences in a new framework and separate these from her experiences with her loving adoptive family. This, along with continued, consistent and nurturing experiences with her adoptive family, would encourage development.

I knew that I could not use Hughes’s (2006) didactic model for therapy, as Jessica wanted her parents nowhere near the playroom during our sessions. Additionally, any direct talk of her pre-adoption experiences would not be possible with Jessica. Therefore, my challenge was to find a way to do this work in an indirect and unobtrusive way.

Jessica and her parents were aware that I had adopted two children internationally. I strongly felt that this shared experience was invaluable in relating to and understanding Jessica’s behaviours, as well as in empathizing with and relating to her parents. I wanted to be able to draw on this common experience with Jessica but she was not open to engaging in any conversation about her pre-adoption experiences. The question became, “How do I do this?” all the while remaining aware of transference and countertransference issues.

I decided to integrate technology and play therapy. The last 15 minutes of each play session was dedicated to closing activities, which included a story. I thought that I would write a story paralleling my eldest daughter’s adoption story to share with Jessica at this time. I chose my eldest for my story as her adoption experience and its effects were very close to Jessica’s. I divided the story into six “chapters” and put it together in a Power Point slideshow to be projected onto the wall. I called this a Stor-e-Book. At story time I asked Jessica if she would like to watch a slide show and listen to my eldest daughter’s adoption story. Jessica was interested in watching the slide show as long as she could operate the remote to change slides. Armed with the remote control while sitting in the rocking chair, Jessica watched my daughter’s Stor-e-Book over the next six weeks.

The strength of using technology with Jessica was that it was a way to make the very personal more impersonal, and for her to be detached and safe from the content but engaged in the process. I was in control of the content and how much of the story she got each time. Jessica was in control of watching the slides, how long she wanted to view each slide and when to finish the Stor-e-Book if she wanted to (which she never did). I used illustrations that were very generic, as I still wanted to maintain a certain distance. It was important that each chapter ended in a place that allowed for closure. She always looked forward to viewing the Stor-e-Book and would ask at the beginning of each session if she would be seeing my daughter’s Stor-e-Book today. She was given a choice as to when in the session she wanted to watch the Stor-e-Book.

In my daughter’s adoption Stor-e-Book, I was able to demonstrate how memories formed while my daughter was in the pre-verbal stage were responsible for her mistaken beliefs. These implicit memories can be evoked by smell, sight, sound or body sensations. When they are recalled, the reaction can be highly visceral and initiate the “fight or flight” response. (Levine, 1997, Eldene, 2011.). For this reason I referred to this in mydaughter’s Stor-e-Book as “body memory.” I spoke of how my daughter’s body memory changed over the course of the years, and how even now, as an adult, her old body memory still comes sneaking back at times. The Stor-e-Book showed the messages that the body memory gave my daughter and how skewed they were from fact.

From Jessica’s reaction and interest in the adoption Stor-e-Book, I sensed that hearing more stories about others’ adoption experiences was important to her. I still knew that she would not accept these stories in book form. So, I scanned and made a power point slide show of the book called The Red Blanket (Thomas, 2004), which she watched the next week. At the end of this story Jessica asked, “You have another daughter, don’t you?” I replied that I did and I asked if she would like me to write my second daughter’s Stor-eBook for her. She said that she would. I related this second story to her in much the same way: using language that was now familiar to her and repeating themes that she had seen in the first Stor-e-Book. She jumped in to fill in the details of the story that she already knew: those parts of the story that were common in both Stor-e-Book. She was noticing the shared experiences of my two children: two different children, two different experiences yet with common themes. Furthermore she could see the similarities in a published story that had been written by another adoptive parent. “How I would love to see her notice these same commonalities with her own story!” was my thought at this time.

After completing this second Stor-e-Book, I ventured to ask her if she would like me to write a Stor-e-Book about her. She said, “Yes!!” I had already attained permission from her parents to do this and now got permission from Jessica to get pictures and details from her parents. I wanted to make the Stor-e-Book as accurate as possible.

The following week, I arrived at the office with the first chapter of Jessica’s Stor-e-Book. She was very excited when we read it and was thrilled when she saw pictures of herself and her parents in the Stor-e-Book. When I read to her about how her body memory started to give her inaccurate messages very early in her life, she commented to me, “My body memory is very old.” This was the first time since reading all the Stor-e-Books that she related herself to any part of the story or that she ever directly disclosed anything about herself.

The play in her sessions was starting to show different themes, themes of nurturance, tenderness, safety and adoption. At home, Jessica’s parents were noticing that she was starting to relax, take some risks and was even beginning to allow them into her very guarded, private world, albeit only very briefly. Was she testing out a new reality? In the following session Jessica was very anxious to get to her Stor-e-Book, asking to shorten the playtime so that she could view it. Jessica listened and was very focused. While we were reading the part where she first met her adoptive parents, I read things like, “The mommy looked at Jessica with such love in her eyes.” or “You could tell by the smiles on mommy, daddy and Jessica’s faces that this was a happy family.” She paused at these slides and studied the expressions on everyone’s faces. Was she starting to believe that she was truly loved? Was she beginning to trust?

According to Perry and Hambrick (2008), repetitive experiences are needed for traumatized children to be able to trust and bond. These include “positive, nurturing interactions with trustworthy peers, teachers and caregivers … Other examples are dance, music, or massage.” (Perry & Hambrick) I believe that Jessica is receiving this nurturing interaction indirectly through the Stor-e-Books. In them, she repeatedly hears that loving parents rock, sing, read, and play with their children. Meanwhile, at home, Jessica’s parents continue doing all of these things with her. Her parents are aware that new neuropathways need to be formed and that repeated, consistent, nurturing experiences are necessary for this (Perry & Hambrick, 2008). Her early, inaccurate body memory needs to be reshaped in order for Jessica to acknowledge and take in positive experiences, and to be able to trust that her adoptive parents will not abandon her. At the time of writing this article, I have only read two of the seven chapters of Jessica’s Stor-e-Book to her. My intent is to burn a DVD with the Stor-e-Book on it for her to take home to watch with her parents. It is my hope that this DVD will be viewed often by Jessica and her parents and will inspire many other healing interactions.

* Identifying details have been changed to insure the anonymity of my client.

Reprinted from Play Therapy magazine with expressed permission of the Association for Play Therapy © 2012.

Update

Since the publication of my initial work with Jessica, there have been a few interesting developments that offer increased support for this approach in our therapeutic support of children.

Jessica continued to be very interested in listening to her Stor-e-Book at the end of each play session. Her play began to have consistent themes around nurturing and interaction, for example: Mommy and baby animals interacting and having loving dialogues together. Something was shifting.

Meanwhile, Jessica’s parents were anticipating some predictable, anxious behaviours; Jessica was about to start a new school year and historically she had difficulties with transitions. As the first week of the new school year came and passed, her parents were happy to report that the year began without incident. A couple of weeks later Jessica’s parents went to their first parent-teacher interview and the teacher told Jessica’s parents that she had yet to see the child that they were describing to her. Jessica was actively participating in class, getting her work done and was cooperative. Meanwhile at home Jessica was: getting her homework done without her parents having to remind her, cleaning her room regularly, cleaning out her hamster cage and was parting with old toys that she no longer needed.

There was one more chapter of Jessica’s Stor-e-Book to read but Jessica and her parents went on a two-week family holiday. The timing of this holiday could not have been better planned as now Jessica could experience firsthand the love, attention and nurturance from her parents that had been described in the first six chapters of her Stor-e-Book. The family had a great holiday with very little incident. Once back home, Jessica continued to be more cooperative and easy going. She was not arguing with her parents and was able to accept the boundaries that they were setting.

As we know, the healing journey does not necessarily follow a linear path and in the last three weeks Jessica has been showing many of her old behaviours. However, Jessica and her parents both experienced a harmonious time where bonds were strengthened; they had opportunity to experience their relationship differently. According to Hughes (2006) the stress of integrating new experiences of self and relationships with others is great and cannot be constantly maintained; Jessica’s parents will continue to experience the roller coaster of emotions and behaviours. My experience has shown, that as time goes on, the ride smoothens out, the ups and downs are less intense and the duration of the ups increase as the downs decrease. The journey for Jessica and her parents continues.

References

Eldene, S., (2011, December 7). Re: Trauma and memory: Part I (Web log message). Retrieved from http://www.oplcenter.com/oplblog/trauma-and-memory-part-i

Hughes, D. A., (2006). Building the bonds of attachment: Awakening love in deeply troubled children. Lanham, MA: The Rowman & Littlefield Group, Inc.

Levin, P., (1997). Waking the tiger: Healing trauma. Berkley, CA: North Atlantic Books.

Perry, D. B., (2001). Bonding and attachment in maltreated children:Consequenes cof emotional neglect in childhood. Retrieved from http://www.childtrauma.org/images/stories/Articles/attcar4_03_v2_r.pdf

Perry, D. B., (2009). Examining child maltreatment through a neurodevelopmental lens: Clinical applications of the neurosequential model of therapeutics. Journal of Loss and Trauma, 14, 240-255.

Perry, B. D., (2012, May). Neurobiology of trauma and attachment: How we are wired. Conference hosted by Stepping Stones Counselling Group, Kelowna, BC.

Perry, B. D. & Hambrick, E. P., (2008). The neurosequential model of therapeutics. Reclaiming Children and Youth, 17(3), 38 – 42.

Thomas, E., (2004). The red blanket. New York, NY: Scholastics Inc.