Reality Play Therapy is something I find essential to integrate into my Play Therapy practice.  Check out more on Reality Play Therapy HERE and HERE. The 5 Needs described in Choice Theory are foundational to my parenting work with families. 
 
The 5 Basic Needs according to Reality Therapy and Choice Theory are: 
 
Survival
Physiological need for survival and sustaining life including physical health, shelter, nourishment, and feelings of safety and being secure. 
 
Love and Belonging 
The drive and need to connect with others including friends, family, classmates, pets, spiritual communities, sports groups, online communities, etc.
 
Power
The desire to matter, have competence, the ability to achieve and make a difference.  This need encompasses self esteem and the desire to have an impact.
  
Freedom 
The need to have age appropriate independence, choice, and autonomy.  Being able to make choice without restriction, which also includes creative freedom. 
 
FUN
The need for pleasure, PLAY, humor, relaxation, and relevant learning. 

One of the most important things in working with children (and humans) is identifying what is underneath the behavior.  And often, more than one need can be at play.  If we can explore with children (as the expert in their world) what needs they were attempting to meet in a non judgmental way we can then begin to empower children to evaluate how effective or helpful their choice was.  
 
Let’s face it, most often children come into therapy for unhelpful choices.  One of the basic premises in Choice Theory is that our thoughts and choices lead to our physiological responses and feelings.  So, children come into therapy for overwhelming and uncomfortable feelings and physiological responses that are a product of thinking and choosing. 

So....if we want to shift thinking and behavior then we have to explore what needs the behavior was attempting to meet! 

If this seems like something you want to start using in your practice grab this FREE DOWNLOAD to help support you in explaining the basic needs to children and families as well as a set of questions to help clients and families explore how well each basic need is being met! 

I learned about Reality Therapy in my grad school program and was instantly hooked!  It is described as a brief counseling approach and a client centered form of Cognitive Behavioral Therapy.  The client centered nature of the approach is so important for children, who often perceive they do not have much control over their lives or have adults and systems making the rules leading to high levels of powerlessness.  
 
Reality Therapy allows children to become empowered to take control over their lives, make decisions, and evaluate the effectiveness of choices.  Through Reality Therapy children (and parents) can learn about what needs are driving their behavior in a compassionate way and help the adults in their lives have a deeper and nonjudgmental understanding for what drives behavior. 
 
Reality Therapy was developed by Dr. William Glasser and is based on Choice Theory. Choice Theory is based on the premise that we only have the power to control ourselves and limited power to control others. Choice Theory is the springboard for Reality Therapy, which is the interventions and implementation of Choice Theory in therapy.  

Want to learn more?  Check out this overview of how Reality Therapy works! 
 
Reality Therapy believes that all behavior is purposeful to meet needs. The 5 basic needs include:

• Power: a sense of self-worth, expertise, and achievement 
• Love and belonging: being part of something including family, community, group, peers, etc.
• Freedom or independence: the ability to make independent choice 
• Fun: a sense of satisfaction or pleasure 

All behavior is Total Behavior: 

• Acting 
• Thinking 
• Feeling 
• Physiology 

 
Distress and psychological symptoms are caused by: 

• Unsatisfactory or non-existent connections with important people 
• A disconnect between:
  • Quality World (where we store mental pictures or representations of wants including people, places, things, values, and beliefs that are important to you) 
  • Perceived world (our experience of the real world that comes through our five senses) which is passed through our Total Knowledge Filter (a representation of everything you know or have experienced in life)
• Individual choices (behavior and thinking patterns) 

The goals of reality therapy are:

• To increase positive connections with others
• To take control of improving their own lives and make better choices to meet needs
• Discover alignment between satisfying Quality World, needs, and behaviors​

The fun part about this? Reality Therapy is a wonderful theory that can be integrated with Play Therapy in a theory called Reality Play Therapy!  Techniques such as drawing, Sand Tray, puppets and so much more can help children explore how they meet their basic needs, gain control over their choices, evaluate choices, and process and explore different ways of thinking and acting! 

It’s something I have been working into my Play Therapy practice with children and adults since I first learned about it in graduate school and helps children and parents both have compassion for themselves as well as empower children to change and have power over choice! 

Drop a comment below and let me know if Reality Therapy is new to you or an intervention you have been using in your Play Therapy Practice!

Cognitive Behavioral Therapy is an umbrella term. 
 
Cognitive Behavioral Therapy (CBT) is a form of therapy that focuses on thoughts, feelings, and behaviors and has been found to be effective in treating mental health diagnoses such as anxiety, ADHD, depression, separation anxiety, trauma, phobias, and the list goes on! 
 
Overall CBT believes: 

• Psychological difficulties are a product (in part) of unhelpful thinking patterns
• Psychological difficulties are a product (in part) of learned patterns of unhelpful behavior 
• People with psychological difficulties and problems can:
  • Learn better ways of coping (shifting thinking patterns and altering behavior) 
  • Can relieve symptoms and become more effective in their lives 

 
Dr. Aaron Beck is widely recognized as the Father of Cognitive Behavioral Therapy and founded, with Dr. Judith Beck the Beck Institute.  Check out this quick introduction to Cognitive Behavioral Therapy.

There are other types of CBT that shift to focus more on thinking and theories such as Rational Emotive Behavioral Therapy developed by Dr. Albert Ellis.  These models were developed as talk therapy approaches, which…well… doesn’t work great for kids.  
 
The awesome news is that there have been many adaptations of Cognitive Behavioral Therapy approaches and techniques to integrate play to make it more developmentally appropriate (and effective) for children.  
 
I wanted to share three types of Cognitive Behavioral Therapy I think are essential in any child therapy practice:
 
Cognitive Behavioral Play Therapy:
 
Okay this one is a given and definitely my default when working with children! Cognitive Behavioral Play Therapy was developed by Susan Knell in 1998 who drew on influences of Dr. Aaron Beck, Dr. Albert Ellis, and Dr. Albert Bandura.

Phases include introduction and orientation, assessment, the middle (or working) stage, and termination. Susan Knell developed the model to have both structured and goal oriented activities and unstructured activities to allow for the child’s spontaneity to emerge and allows the gathering of essential information about the child’s world.  Knell notes that the focus of CBPT is on “directions and goals, choice of play materials and activities, play as educational, and the importance of making connections between the child’s behavior and thoughts”.  Techniques include modeling, role play, direct and indirect approaches, and classical and operant conditioning. 
 
Want to add some Cognitive Behavioral Play Therapy tools to your toolbox?  Check out these interventions, activities, and downloads here:  

• A bibliotherapy intervention and free downloadable worksheet for shifting cognitions 
• 4 calming crafts to make in your office 
• Free downloadable cards for adaptive self statements 
• 5 Bibliotherapy techniques for emotional regulation 
• 3 Play Therapy activities with bubbles (including popping maladaptive thoughts) 
• Exploring the Cognitive Triangle with Giraffes Can’t Dance (free download included) 
• Shifting cognitions with Big Feeling Eaters 
• Teaching emotional literacy and expressing thoughts and feelings with Play Dough Feeling Faces 

 
Dialectical Behavioral Therapy:  

Dialectical Behavioral Therapy (DBT) was developed by Marshal Linehan in the late 1980’s for adults with intense emotions. Four modes of standard outpatient DBT include individual psychotherapy, DBT Skills training, in-the-moment phone coaching, and DBT Consultation Teams for therapists.  Skills foundations include mindfulness, distress tolerance, interpersonal effectiveness, and emotional regulation. 
 
Dialectical Behavioral Therapy has been adapted for children in DBT-C for pre-adolescent children with severe emotional dysregulation and corresponding behavioral discontrol and requires formal DBT-C training to implement the model with fidelity.

DBT-C includes four main categories including: 

• Decrease risk of psychopathology in the future
  • Life-threatening behaviors of a child
  • Therapy-destroying behaviors of a child
  • Therapy-interfering behaviors of parents
  • Parental emotion regulation
  • Effective parenting techniques

• Targeting the parent-child relationship
  • Improve the parent child relationship 

• Target the presenting issues 
  • Risky, unsafe, and aggressive behaviors
  • Quality-of-life-interfering problems
  • Skills training
  • Therapy-interfering behaviors of a child

One of the foundations of this model is teaching parents all the skills their child learns as well as effective contingency management techniques, focus on parent modeling of adaptive behaviors, reinforcement of skill use, ignoring maladaptive responses, validation, and acceptance.  Overall this model is used to help children and families create a life worth living while validating distress as well as pushing for change.  
 
While official training is necessary and ethical to carry out the DBT-C model with fidelity, if your agency and practice does not have the training you can use and teach the DBT skills by incorporating these skills into Play Therapy techniques.  
 
Check out some ways to incorporate DBT skills into your Play Therapy practice HERE: 

• Rainbow meditation and deep breathing 
• 4 alternatives to deep breathing for emotional regulation and distress tolerance 
• 30 Day Gratitude Challenge (free download) 
• 5 playful ways to teach deep breathing 
• Bibliotherapy gratitude technique 
• Mindfulness, gratitude, and emotional regulation scavenger hunt (free download) 

Reality Play Therapy: 

I learned about Reality Therapy in my grad school program and was instantly hooked!  It is described as a brief counseling approach and a client centered form of Cognitive Behavioral Therapy.  
 
Reality Therapy was developed by Dr. William Glasser and is based on Choice Theory. Choice Theory is based on the premise that we only have the power to control ourselves and limited power to control others. 
 
The goals of reality therapy are to help increase positive connections with others, meet our 5 basic needs, and overall help the client discover alignment or disconnect between satisfying Quality World, needs, and behaviors. 
 
Reality Therapy believes that all behavior is purposeful to meet needs. The 5 basic needs include survival, love and belonging, power, freedom, and fun.

​Distress comes when there is a disconnect between our Quality World (where we store mental pictures or representations of wants including people, places, things, values, and beliefs that are important to you) and your perceived world (our experience of the real world that comes through our five senses).  Our perceived world is passed through our Total Knowledge Filter, which is a representation of everything you know or have experienced in life. 
 
Reality Therapy has been combined with Play Therapy in research starting in 2011 with Eric Davis who combined the WDEP technique in Reality Therapy with drawing.  Since then the has been research and integration of Reality Therapy and Play Therapy in a model called Reality Play Therapy.   
 
And there you have it! Three types of Cognitive Behavioral Therapy you can integrate into your practice with children!  
 
Drop a comment below to let me know if you use any of these theories and techniques in your practice OR if anything here makes you want to learn more! 

Life can be so busy as a child therapist.  You are trying to be present for your clients, provide the most evidence based and effective treatment modalities, oh...and then there are the “other things” that get shoved between client sessions and in the random client cancellation. 
 
You know, the phone calls, emails, preparing and sending records, and the client crises.  As much as we can strive for wonderful outside of session boundaries - things happen that we need to attend to, like documentation for IEPs or provider coordination calls.  
 
Oh ya - and the documentation, writing notes, updating treatment plans and annual assessments, and all the other assessments and bits of information that need to be in client files. 
 
Wheeew - so in all of that I wanted to catch you up on some of my top blogs visited in 2021 that thousands of therapists have found benefit in. 
 
 In case you missed any of these here are my top 10 visited blogs in 2021: 
 
Telemental Health and Children: 20 Free and Minimal Supply Activities 
This blog will give you 20 free and minimal supply activities you can use both for Telemental Health and in person.  It gets right to the good stuff with all of the resources in one place! 
 
The Color Monster: Free Downloadable Worksheet Set
A completely free downloadable resource to use as a companion with The Color Monster book! Did you know that research shows that adding an activity with a Bibliotherapy makes it more effective?  Well… now you do! 
 
Play Therapy Progress Note Tips 
Okay - most of us struggle with writing effective progress notes.  Now what about as a Play Therapist?  Here are some of my top tips to communicate the therapeutic benefits of activities such as “giant tornado ball crushes city” and “7 rounds of UNO”.  
 
Covert Calming
This blog is FULL of activities to help young people regulate and calm without putting out a flashing beacon that they are working on regulation skills. These are pure gold for young people who struggle with utilizing skills because  they are worried what others will think. 
 
4 Calming Crafts to Make in Your Office  
Get inspired with ideas of low prep/supply crafts to make in your office and for your client’s to take home that will help with calming and regulation.  
 
5 Playful Ways to Teach Deep Breathing 
Recently at a training I asked everyone to raise their hands if they had clients who were excited and fully on board to learn one of the most effective strategies backed by neuroscience for regulating emotions - deep breathing!!! Yay!!
 
Okay - nobody raised their hands and I’m not surprised.  Most young people aren’t so excited about learning this skill, so this blog is full of creative and playful ways to get kids to learn and actually use deep breathing! 
 
Bibliotherapy: Giraffes Can’t Dance
Remember above that bibliotherapy interventions are more effective with a paired directive Play Therapy activity? Well - here’s another one for you complete with a FREE downloadable worksheet!  Giraffes can’t dance has it all - growth mind set, shifting cognitions, and an adorable giraffe Gerald! This is definitely in my top 3 Bibliotherapy books!! 
 
The Portable Playroom: Comprehensive Play Therapy Kit Source List  
One of my most frequently asked questions is around what toys a therapist should buy when working with kids.  Oh - and a lot of therapists I work with for supervision/consultation have a portable practice where they are going in home, to multiple schools, or are in different offices.  
 
These kits were developed inside of the pandemic as a resource I sent to child client’s so we could continue our Play Therapy with a version of my playroom brought right into their living rooms, bedrooms, or wherever they were playing.  
 
So - let me do the heavy lifting for you!  This is a comprehensive guide with all my source links for you to check and out!
 
Sand Tray and Miniature Kit: Source List 
Sand Tray is one of my favorite modalities to work with children.  This blog holds a source list of sand tray miniatures, where to get sand tray containers that are portable, and my favorite sand.  It also includes a list of free or found objects that are a great addition to any Sand Tray practice! 
 
Free Download: 15 Calming Affirmations for Kids 
If you are working on shifting thinking patterns with young people this is an excellent and FREE resource to help young people identify that adaptive and intentional thoughts that they would like to occupy their minds.  Cognitive Behavioral Therapy is all about shifting cognitions to adaptive to help people feel better and act in the ways that work for both them and the world around them.  Help young people get intentional with these free (and oh so pretty) downloadable cards! 
 
There you have it!  The top 10 visited blogs from The Playful Therapist Blog in 2021.  Blogs come out each week on Wednesday and cover a variety of topics from Play Therapy interventions, free downloads, tips and strategies for documentation, and practice elevating resources.  

And if you want even more resources sent straight to your inbox join my email list HERE!

Creating a vision board is a fun, engaging, and playful way to help middle schoolers and teens to help think about the goals and create hope and excitement for the future.  
 
Did you also know that vision boarding is backed by research and neuroscience as a way to help young people move towards their goals?
 
The first way this is true comes back to research about the “common factors” that make therapy effective.  I talked HERE about the number one factor that predicts success in therapy, which is the therapeutic relationship!  
 
The number two factor? Well, that just happens to be hope. Hope for the future and hope that things will get better.  Without this hope and vision, young people will struggle to put in the hard work it takes in therapy because they really don’t believe that things will be different. 
 
Vision boards also help your brain identify and grasp opportunities that may have otherwise gone unnoticed.

Neuroscientist Tara Swart explains it like this - our brain has a process called “value tagging” which is a system for imprinting important things onto your subconscious.  Items that are “value tagged” are assigned a higher value and seen as more important.  Information that is seen as unnecessary is filtered out.

By creating a visual representation of your goals you are telling your brain these things are important to you and your brain will begin to pay attention to and notice things in your environment that align with these goals instead of filtering the information out. 
 
Now, there is one shift that I make when taking the concept of a vision board and bringing it into the therapeutic relationship.  And, that one thing is willingness.  It’s one thing to put wildly exciting things on a vision board like “climb Mount Everest” or “take a hot air balloon around the world” - but if they don’t like the cold or heights these goals have a slim to none chance of coming true. 
 
So I like to shift the concept of vision board to action board. 

What dreams do they have that they are committed, willing, and prepared to work towards? Getting an A in math class? Driving a brand new car? Traveling to Hawaii? Getting into their top pick for college? Renting their own apartment? Being able to cook dinner? Being the captain of their team or the lead in a play? 
 
Then - you take these big goals and break them down into little bite sized pieces.  Things they can accomplish in a shorter amount of time that brings them closer to their goal.  What activities or volunteer opportunities do they need to have to get into their top college?  What are the steps from getting to barely boiling water to fully preparing a three course meal? What exercise regime will get them closer to scoring more goals? 
 
Grab this FREE downloadable worksheet guide HERE that helps both you and your clients get crystal clear on what the larger vision is and the action steps to get there. 
 
After all of this you can decide on your medium:

1. Digital vision board - Cut and paste different pictures that represent pictures from your brainstorming session.  My favorite way to do this is in Power Point and to use the “remove background” tool to cut out objects.  You format it all together and hit print! 
2. Collage vision board - Here you bust out the magazines (from a wide variety of subjects/mediums), paper, scissors, and glue.  (It takes me back to 6th grade where every time I would buy new shoes you better believe that shoebox was getting a full collage makeover!) Then cut out pictures, words, and sayings that represent the goals. 
3. Sand tray - You can have the client create a sand tray with miniatures that represents what the future looks like according to the vision board worksheet pictures they identified.  You can take a picture of the tray and print it out. 
4. Art - For this - anything goes!  You can have your client create an original piece of art including all the components from their idea list.

Don’t forget to grab this FREE downloadable worksheet guide HERE to help you make vision boards therapeutic, fun, and effective! Now – get dreaming! 
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Updating your Play Therapy gear and toolbox can be expensive.  The trainings.  The toys….So. Many. Toys. EEEK! 
 
BUT I wanted to give you some inspiration and tools that are totally, completely, 100% free.  Okay not completely free - they will cost you some printer paper and ink.  But beyond that - totally free! 
 
Sometimes we hit a wall as therapists and want to mix up our old standbys.  I think that is what makes me so excited to create worksheets, develop and tweak techniques, and always put myself in the role of a learner.  
 
When we feel burnt out or a little stale because we have taught emotional regulation with UNO all week - kids feel that. AND when we get excited about a new technique, toy, or way to help move them towards their goals - well, they feel that too! 
 
I wanted to give you my top 5 downloaded resources this year that thousands of therapists have integrated into their practice! And chances are, your clients might like them too!
 
Therapeutic Scavenger Hunt Pack 
This Scavenger Hunt pack is FULL of creative ideas to get young people moving, and having fun! The bundle includes scavenger hunts for Mindfulness, Gratitude, Self Esteem, Nature and Emotions.  I originally developed these hunts when I was in an all virtual practice, and now that I am hybrid (some in office, some virtual) I still find such value in scavenger hunts.  
 
Some tweaks for in person?  Do a gratitude walk from the waiting room to your office to see how many things you can find gratitude in!  Give hunts as homework to bring into the next session or take a picture of the object to share! 
 
The Color Monster Worksheet Set 
Who can resist The Color Monster by Anna Llenas!  It is such a wonderful overview of emotions, how they can get tangled up, and the gentle ways we can untangle and make sense of the big feelings we might have.  
 
This worksheet set comes with a Color Monster that young people can color in to talk about their day or week and jars to help them “untangle” the big feelings! 
 
Giraffes CAN Dance Worksheet Set 
Okay, so if you came up to me and said “Ann, what is your favorite book for kids?”...well...it would be such a HARD question for me (because books are my favorite) BUT Giraffes Can’t Dance would be in the top 3. 
 
This book has it all! Growth mindset, shifting thoughts from maladaptive to adaptive, and relying on the support of others.  This worksheet bundle captures all those topics AND a little bit of empathy and social skills with a worksheet targeted at how the young people in our office help and support others! 
 
Child and Adolescent Interactive Goal Setting Worksheet 
Have you ever asked a child or adolescent what they wanted to work on in therapy and you are met with a blank stare? I mean…. I would really question you if you said it hadn’t!  That’s just how kids brains are wired.  They are not “mini-adults” and let’s face it - most adults need a little coaching with goal development too!  
 
This worksheet set is super interactive, fun, reflective and of course involves coloring! 
 
15 Calming Affirmations for Kids 
Sometimes we have things that we know are backed by science that really helps move client’s towards emotional wellness.  And a lot of the time (children and adults alike) have a hard time adding something or changing something about their routine that they know will be good for them.
 
This is why if I can give my clients a take away, handout, printable, fidget, journal, etc. that goes with what we are working at - I jump at the chance! When there is a physical object that they can connect with the activity and leave out for themselves to see it increases the chance they will act!  
 
These affirmation cards are some of the most common affirmations I have developed with young people such as “I can do hard things” and “I am loved”.  And re-wiring thinking patterns never looked so pretty! 


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There you have it! My top 5 download FREE resources.  And did you know - it doesn’t stop there?  I have 29+ FREE downloadable resources for both client work, paperwork, and therapy practice elevating! Check out all the resources HERE! 

One of the most valuable things we can do as clinicians is to support parents in their day to day life with their children.  I truly believe parents and caregivers are the most important people in a child’s life.  
 
The healing principles of attachment and co-regulation drastically outweigh the support as a therapist that I can give to a child in one hour of therapy per week. Because of this I see parenting work as an essential part of working with children.  See more about emotional regulation HERE, and co-regulation HERE and HERE! 
 
The following metaphor was one I heard on the podcast Stuck Not Broken (which is amazing by the way!) that I use all the time when working with parents.  I LOVE a good metaphor, especially one that creates new insights or provides different ways of looking at things and ultimately leads to parents being able to hold the space that children need to heal. 
 
What I know about parents is the vast majority (with a few exceptions) are doing the best they can with what they have.  They are exhausted and trying everything they can to get their child to feel better and do the things they know their child wants and needs to do.  
 
And sometimes? Well, sometimes the only tool left in the toolbox is yelling. Sometimes parents take the parenting strategies that their parents used in an attempt to support their child.  
 
Some parents doubt that co-regulation (check out this guide I use with parents HERE!) is necessary or can be effective. This might mean having ideas that the child needs to “toughen up” and “just get over it”.  Other times I hear “yelling is the only thing that will work” or “I just didn’t know what to do - I lost it!”. 
 
During these times I like to share this metaphor: 
 
“You can’t get a turtle to come out of its shell by banging on the shell”. 
 
Let that sink in for a minute. 
 
Any time a child is not connecting with you and is behaving in ways that are dysregulated (throwing, crying, hitting, hiding, etc.) at the end of the day it means they do not feel safe.  
 
Their nervous system has a neuroception of danger. (Learn more about neuroception of safety in therapy HERE and HERE). 
 
The turtle in its shell is not going to come out unless it feels it is safe. 
 
Turtles don’t feel safe when yelled at or when something or someone is knocking on the shell.  Turtles have long game.  They stay in that shell until they feel safe. 
 
The same is true with children.  They will not...they CAN’T feel safe if we are yelling at them, looking at them with an angry face, or talking down to them.  Telling kids to “calm down” or “just get over it” has never in the history of parenting been an effective strategy for regulation.  
 
These strategies make children feel minimized or shamed for their emotions and more importantly they feel pretty darn disconnected from parents. AND when parents are upset, angry, or yelling children’s nervous systems tune into that and their dysregulation can increase. 
 
 I also think it’s not super fair to young people that we would expect that young people would be able to regulate (with an under-developed prefrontal cortex) better than an adult who is yelling, grumpy, or losing their cool. 
 
And hey! We all lose it sometimes, but a clear understanding of brain development can help parents understand that their child isn’t feeling safe and has less ability to regulate emotions than an adult. This understanding can help bring compassion from adults both towards themselves and their children. 
 
So….what does help? 
 
Justin Sunseri, LMFT has this wonderful Co-regulation Quick Guide HERE that I often share with parents and caregivers. 
 
At the end of the day getting the turtle to come out of it’s shell (or child to regulate) means being a safe external co-regulator.  
 
It means being able to give a child cues of safety so their nervous system can understand that there is not a significant threat of danger.  This might mean having gentle eye contact, getting below eye level, and being intentional on what you say. 
 
When children (or anyone) is in fight or flight mode their inner ear muscles turn off leading to tuning into sounds of danger (low pitched and high pitched) and less into human voices.  This can lead to difficulty with comprehension and understanding of words and language. 
 
Additionally the limbic regions are most active and the prefrontal cortex can go offline - ie decision making, logic and reason. So because those brain regions are not active and available to a child, parents may be saying the most brilliant things, but unfortunately their child is not in a place to be able to take it in and make sense of it.  It's not that they don’t want to, they just can’t. 
 
At the end of the day being a safe adult will allow the child to feel safe enough to regulate and have access to the prefrontal cortex.

​And that my friends? Well… that’s where the good stuff happens.  The conversations, healing, growth, increased understanding, and learning.  


Want to learn more about Play Therapy and the neuroscience of regulation? Check out this training HERE! ​​

 
Co-regulation is an essential concept for parents to understand in moving towards mental wellness for their child.  I do a deeper dive on co-regulation HERE and emotional regulation HERE, but wanted to address some of the most common misconceptions, questions, and concerns I get from parents when we talk about co-regulation.  
 
If parents have been raised in a family system with more of an authoritarian parenting style, have beliefs that their child should be “old enough” to do the things they want and need them to do, are used to structuring the environment to remove the majority of barriers and distress for their child, or are just plain exhausted they may be a little skeptical about co-regulation. 
 
I wanted to address the six biggest questions or concerns parents have when I talk about co-regulation and how I respond in session. 

1. “If I drop everything to regulate with my child isn't that "giving in"?”  
Sometimes parents will mistake co-regulating with their child as "giving in".  Like, if they stop and spend time with their child regulating that the child has “won”.  BUT this is absolutely not the case.  When we co-regulate we are giving the child what they developmentally need to calm their brain and begin to use the higher brain regions again – the parts of the brain that are logical, reasonable, and that are able to do what is needed and expected. One of my favorite quotes from Robyn Gobbel says it all “regulated connected kids who feel safe (and who know what to do) behave well".

2. “So I should just give in or give my child what she wants when she is upset?”  
Now sometimes parents use giving into their child as an actual strategy to regulate. Like giving the child who is sobbing and dysregulated at the cash register the candy they want to soothe them after a limit had already been set. This is such a tricky one because in the short term the child will likely regulate once they get what they want quicker than if they do not.  However, what this can reinforce and teach a child that dysregulation is a tool to get what they want - ie when I become dysregualted my parents give in.  It develops what we call a "secondary gain".  This can overall lead to increased levels of dysregulation. It also doesn’t help them widen their window of tolerance and ability to tolerate things in their environment when they are distressed.  

3. “So I can’t set limits, boundaries, or have natural consequences when he is upset and tantruming?”.  Some parents believe that if the goal is to co-regulate then that means there shouldn’t be any limits, boundaries, or consequences.  Well, it’s actually the opposite! Consistent limits and boundaries can actually make a child feel safer and regulate quicker. They know a parent is serious and will follow through. Limits and boundaries for safety can absolutely happen during dysregulation, however the child’s capacity to actually hear and understand consequences should wait until the child is regulated and has access to those reason and logic parts of their brain. Limits or boundaries set should use simple short sentences without any lecture or explaining and should be given with cues of safety.  

4. “If I set a limit or give a natural consequence after the tantrum she is just going to get upset again”.  Yes, that could be true! AND natural appropriate consequences are what promotes learning to help widen the window of tolerance and ability to handle distress.  Short term a child may get upset again quickly, but longer term skills will be built to increase distress tolerance. This also helps parents establish themselves as safe and consistent so the child knows what to expect. Also limits and natural consequences should be given with care, empathy, and connection. 

5. “So I should just let my child yell at me or say whatever they want to me?” I have many parents that say “okay - so I just let them walk all over me?”.  Well, not exactly.  You want to make sure as a parent you give safe and social cues (see above) and at the same time hold limits and boundaries (again see above).  One of the boundaries during dysregulation (if a child is physically safe) might be a parent sharing that they are willing to problem solve the math homework as long as the child has a calm voice.  

6. “So I can’t show my own emotion?” Yes! Parents can absolutely have and express their own emotions, as long as they are in their window of tolerance.  Parents can express they are sad, mad, anxious, or disappointed as long as they do so in a regulated controlled way.  If it comes out with yelling, violent behavior, the child feeling like they need to comfort the parent, or the parent centering themselves it is likely the parent needs a break.  This might mean taking some time to be alone in their room (modeling), regulating themselves, or seeking connection from one of their social supports.  It is always better to leave and have a break to regulate than staying in a conversation or situation where the parent is going to go out of their window of tolerance. 

7."Why should I change when yelling works?”.  Yup, sometimes it does.  This is usually because young people feel a threat or danger cue from the parent and feel unsafe and fearful to the point they can regulate enough to get through the situation.  Usually the feeling is repressed and the “expected response” is given at the expense of feeling safe within the relationship.  This usually leads to more dysregulation down the road (because if yelling “solved” the problem families would not be presenting for therapy) and harm to the attachment relationship.  If we expect children to be regulated we need to model regulation as adults. 

Want to learn more about Play Therapy and the neuroscience of regulation? Check out this training HERE! ​

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Emotional regulation is the ability of our nervous system to control or regulate emotional responses to something our nervous system deems threatening. It is the ability to stay mindful, present, and work through emotions while our prefrontal cortex (logic, problem solving and reasoning) stays active! Check out a deeper dive on emotional regulation HERE! 
 
Emotional regulation can be broken down into co-regulation (someone outside of ourselves is supporting regulation) or self-regulation (the regulation mechanisms we do by ourselves or on our own). 
 
Co-regulation is a complex process that develops within the attachment relationship and starts at infancy. It is developed through an attuned caregiver who is able to provide consistent and safe responses to an infant's distress.  The attunement, attachment, and regulation skills are imprinted in memory and form the basis for self-regulation. 
 
In short, co-regulation in the attachment relationship lays the foundation for self-regulation.
 
Dr. Allan Schore describes the attachment relationship as how a mother helps the infant regulate emotion.  And these neural patterns and connections?  Well, the infant takes these patterns as a map of regulation that the infant will use across their life. 
 
Going further Dr. Schore states that “attachment theory is essentially a regulatory theory, and attachment can be defined as the interactive regulation of biological synchronicity between organisms.” He also sees an early task of development as transferring regulation from exclusively externally driven (co-regulation) to internal driven (the ability to regulate self). 
 
Many of the young people we see may have had preverbal trauma, a dysregulated caregiver, or other distressing life events that disrupted the attachment relationship and led to difficulty regulating in the here and now. 
 
AND our need for co-regulation doesn’t stop once our capacity for self-regulation develops. As humans we never stop needing the support, understanding, validation, and empathy from others. 
 
So just what exactly does co-regulation look like?  
 
The three pillars of co-regulation according to Duke University are:

1. A warm responsive relationship by showing care and affection and identifying and responding to cues of distress, wants and needs.  This also means building strong relationships by supporting the child in times of distress and genuinely caring about the interests and world of the child.  A warm and responsive relationship also means showing the child respect and unconditional positive regard. 

2. Structure the Environment by providing a “buffer” against environmental stressors by creating an environment that is developmentally appropriate and physically and emotionally safe. This creates an environment where a child is able to learn and explore their environment in a safe way.  This also means predictable routines and expectations. 

3.Teaching and coaching self regulation skills through parent modeling, teaching, and practice. This also might mean the parent holds the structure and prompts skill use and reinforces successful regulation skills.  We can’t expect children to know how to regulate if they don’t have the tools in their toolbox!   
Another truth?  When you work with kids, you work with parents. AND you need to become really comfortable teaching parents about co-regulation with their child. Because co-regulation helps develop self-regulation!
 
Children who have deficits in self regulation capacity need a supportive, attuned, consistent, and safe caregiver to help them imprint and encode these neural patterns and connections until they are strong and engrained enough that the child is able to access them without their caregiver. 

Want to learn more about Play Therapy and the neuroscience of regulation? Check out this training HERE! 
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Nearly every child that walks through my door has difficulties with regulation. (I would say 100% but I am not an absolute kind of gal.)
 
According to the American Psychological Association emotional regulation is the ability of an individual to modulate an emotion or set of emotions.  (Check out my 4 truths about emotional regulation HERE! )
 
Due to early traumatic life experiences, genetics, and/or the attachment relationship most of the young people that come into my office are struggling with their gas pedal.  
 
Some are pressing down hard on the gas leading to high intensity of emotion (sympathetic nervous system activation with increased heart rate and breathing, upset stomachs, sweating, etc.).  These are the kids that are angry, throwing things, tantruming, having panic episodes, or crying. 
 
Other kids are slamming on the breaks or putting themselves in park.  These are the kids that are in their parasympathetic nervous system and might be hypoaroused where they are not having a desire to do anything, isolating, and/or are under the covers. 
 
Both are having trouble with their nervous system regulation triggering the fight or flight response. Both sets of responses mean young people’s bodies and nervous systems are deeming something in their environment as unsafe or dangerous. 
 
And this whole reaction? Well it is out of our conscious awareness. We don’t choose fight or flight - our bodies prepare us for action when we are in danger. 
 
Dr. Dan Siegel calls our optimal zone of nervous system arousal our “Window of Tolerance”.  Here we are regulated, able to move through emotions, able to access higher levels of thinking like reason and logic, are able to be mindful, and are able to be connected to our bodies and sense of self. 
 
And what we know is that with higher levels of trauma and stress we are triggered more often by smaller stimuli.  Or more simply - trauma and chronic stress shrink our window of tolerance. 
 
Lisa Dion identifies four threats to the nervous system in her book Aggression in Play Therapy.  They are:

1. Physical Pain
2. The Unknown
3. Incongruence in the environment
4. “Shoulds” and “unrealistic expectations”

 
When we look at this list we can begin to understand why transitions, attempting to hide things from children, or expecting things from children that they are not able to successfully achieve can be deemed scary, threatening, and dangerous.  The child’s amygdala deems these incidents as threatening and scary as if there were a lion in the room.  The nervous system reacts the same exact way.
 
When we go further and think about the filing and storing of trauma experiences we can further understand dysregulation.  We know that  “neurons that fire together wire together”.  This means that in traumatic experiences stimuli that are not connected with trauma can be encoded and stored within the trauma memory and can be an immediate cue for danger. AND it is likely outside the child’s conscious awareness.  
 
They child will not be able to tell you that a specific sound, smell, taste, expression, or body position was present during a trauma.  And at the same time their body is remembering and will start to become dysregulated and go into a fight/fight response. The body will see this stimuli just as threatening or dangerous as the initial trauma. 
 
As therapists we often hear parents say that moods shifted “out of nowhere” or comment that the child was having a great day and then something shifted.  It is likely that in all of the sensory data that is coming into their bodies.  I talk HERE about how our bodies process anywhere from 11 million up to billions of sensory bits of data per second, but only 40-50 bits are conscious.  
 
When we look at this information it makes sense that a child can become easily triggered and it might not make sense to the child or the parent.   
 
Once we can understand the neuroscientific principles that are underlying emotional regulation and dysregulation we can begin to support parents and children in widening the window of tolerance and their ability to tolerate distress! 

Want to learn more about Play Therapy and the neuroscience of regulation? Check out this training HERE! 
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