You love EMDR and learned so much in your basic training! But...there was a lot packed into those intensive training days. You probably have a binder or a manual, tons of handouts, and some practice under your belt.
Maybe you are struggling to pull it all together and get a hang of the basic protocol whether it was two weeks or two years since your basic training. Maybe you are even struggling to start with your first client. Or mayyyybe you are a pro at it and can do all 8 phases with your eyes closed...metaphorically of course!
Either way, for a lot of clinicians, even ones who are really confident in carrying out the protocol with adults, doing this work with children seems overwhelming and maybe a bit scary. Or terrifying.
I meet many clinicians who have an apprehension for diving into this work with children, even if they have been doing it consistently with adults. AND it is so great to name that and acknowledge it, because if you are going into the session anxious, nervous, and not quite sure what to do - your clients will feel that. It will be a neuroception of danger and they will be on high alert too.
Not so great for trauma work. If they know you feel anxious, children might have a harder time staying in their window of tolerance. Bottom line - if you're not quite sure about it, they won’t be either.
SO because of this and knowing how transformational EMDR can be for children, one of my most favorite things to do is to support clinicians in getting confident and prepared to engage in EMDR with children. Getting a clear idea of just how to adapt the protocol to be developmentally friendly for children, so you can be confident to rock an excellent EMDR session!
If you're looking for resources to get you started I talk HERE about what you need to know about children and trauma work. If you are wondering if young people are really ready for trauma work you can read more about that HERE! You can dive deeper into how to incorporate books and play into EMDR HERE.
But, if we start at the very beginning one of the first things we are doing with young people in Phase 2 is giving psychoeducation about EMDR. There are definitely a lot of ways to do this and I find it is a balance between overwhelming clients with neuroscience vs. providing them enough information about how their body and brain stores trauma.
I find that when young people can fully understand just what is happening in their bodies they are more likely to have a stronger buy-in for the EMDR process. BUT you don’t want to send them into an all out snooze fest where their eyes are glazing over.
The solution? Super fun metaphors and some video clips! I like to talk about EMDR using the movie Inside Out. This is a movie that is ripe with scenes that we can watch and apply to how our brain processes trauma and what we are setting out to do with EMDR.
You want in? Swipe my script HERE for how I talk to young people about EMDR in an interactive way using the movie Inside Out!
EMDR is a type of trauma therapy developed by Francine Shapiro that has 8 phases, where a therapist trained through an EMDRIA approved basic training works through the model with clients to help with trauma memories that are disturbing, distressing, and impact functioning. Learn more about EMDR therapy and kids HERE!
Phase 2 is the Preparation Phase. This phase includes establishing a relationship of trust, giving an explanation that is age appropriate of EMDR, learning relaxation and state change activities, developing resources, and increasing the window of tolerance to allow for dual awareness.
EMDRIA states that most clients will need 1-4 sessions of preparation, however for chronic and complex trauma this number can significantly increase. I talked HERE about how to know if young people are ready, really ready, for trauma work. I also talk HERE about the essential ingredients for doing EMDR with young people.
I find that the majority of children that I see are not children who have a single incident trauma. Young people also aren’t voluntarily seeking out a therapist to work on their trauma, the majority of the time. There are also a lot of factors in a child’s life that may lead to instability that they have no control over.
For these reasons here are the top 10 reasons why children and teens may need a longer Phase 2 for EMDR Therapy:
Your training, clinical judgement, and consultation around EMDR cases will always help you understand how to pace your EMDR work with young people. Hopefully some of the examples above help you understand if a client may need a longer phase 2!
What about you? What are your top signals that a client may need an extended phase 2? Drop a comment below!
EMDR and Play Therapy is a brilliant combination for healing trauma.
Children and young people lack the abstract reasoning and verbal processing skills to engage in therapy that is primarily talk based. They also need therapy that is engaging and accesses all portals of learning: visual, auditory, and tactile and kinesthetic.
And this last portal? Well... it happens to be the primary portal of learning for children under 11, so it’s pretty dang important to incorporate touch, movement, and activities into EMDR.
So taking all of this into account having a child sit still and “notice that” isn’t going to get you that far. It will likely either lead to underaccessing, boredom, or flooding outside of the window of tolerance. Which is not a winning combination for trauma work.
Young people are already distressed knowing they are going to begin some form of trauma work. They are smart. Young people know that eventually they will get to the tough stuff.
All of this can leave therapists trained in EMDR a little apprehensive to begin to do this work with children. And I get it! Most EMDR basic trainings have so much to fit in that training comprehensively to modify the EMDR approach for children isn’t something that is achievable.
So it is understandable how many professionals exit the basic training and feel a bit overwhelmed by thinking about starting this work with young people. You can learn more about EMDR therapy and kids HERE and HERE!
AND I always recommended extra training and consultation before starting. You can also check out these three books HERE, HERE, and HERE which are always on my list of recommendations for professionals starting EMDR work with children.
Now when you get down to it and are ready to do this work with young people, my three favorite things to help with engagement and help young people access all three portals of learning are play, books, and games!
Play is an excellent way to help young people keep within their window of tolerance. It also allows young people to communicate in a different way about their struggles, symptoms, and trauma and show you their world.
Engaging in a type of play such as Child Centered Play Therapy can help gain insight into specific Negative and Positive cognitions a child may have relating to their trauma. You might also get insight into specific resources that may be helpful or places there may be blocking beliefs.
Ann Beckley-Forest and Annie Monoaco have a fantastic text on the integration of Play Therapy and EMDR that is a must read!
Play also helps you gain rapport and trust with a young person. Unlike adults, most young people don’t present themselves for therapy with high levels of engagement and motivation to work through trauma. For this reason I believe children and teens may need a longer period of rapport building to increase trust before going into the depths of their trauma. This is especially true for complex trauma as opposed to a single incident trauma.
Play therapy activities such as sand tray, drawing, or other creative activities are also essential for phases 3-8!
I absolutely LOVE books. Books can be used in phase 2 to help with tasks like increasing emotional literacy, emotional regulation, state change, adding adaptive information into appropriate neural networks, and normalizing an experience.
The experience of watching a child as they are able to connect and identify with a book, see themselves in the characters, and the look of relief as they realize they are not the only one to have experienced something is truly amazing. Books are also externalizing and directive so they can be a safer activity to begin trauma work.
Check out these resources HERE, HERE and HERE to help with emotional literacy and emotional regulation! This book HERE is also an excellent resource to help young people identify Negative Cognitions, Positive Cognitions, develop resources and to explain EMDR and trauma processing! It also happens to be one of my most favorite Bibliotherapy books!
Games are another essential to help engage in a strong phase 2, which sets you up for an excellent desensitization and reprocessing of trauma memories. It allows the young person to come in being an expert in identifying thoughts (to help with NCs and PCs), feelings and body sensations. When you ask all the questions for phase 3 they will be ready!
There are tons of Play Therapy games to help increase emotional literacy, identify cognitions, identify areas of resilience and strength, increase window of tolerance (especially practicing losing!), and practice scaling like you will need with the VoC and SUDS.
Check out this article HERE on 3 ways that games with bubbles can help you provide psychoeducation about feelings, engage in state change, and identify thoughts. This game HERE of Strengths and Struggles can help young people identify strengths that are great for resourcing and identify struggles that may be incorporated into Negative Cognitions.
These are my three ingredients that are essential for modifying the EMDR protocol for use with young people! What about you? What are your favorite activities? Comment below!
Is he really ready for the trauma work? What if it gets worse? I don’t know if she can handle it. Is this the right time?
These are real fears that come up for us as therapists who work with trauma, especially when we consider the ethical principle of nonmaleficence or do no harm.
AND as trauma therapists we need to have some objectivity and identify whether the fear is due to the child actually not being ready or if the fear is our own. To piece this apart I wanted to share what goes into my decision making about child readiness for EMDR.
If we ground ourselves in the 8 phase model of Eye Movement Desensitization and Reprocessing (EMDR) the answers to the questions above will become clearer. Specifically asking ourselves “Are the activities that we are doing with young people in Phase 2 Preparation Phase sufficient enough and is the environment stable enough to warrant moving on into working with trauma memories?”
To answer that question we need to look at the work of Dr. Francine Shapiro, the originator and developer of EMDR who gives clear identifications of the factors for readiness for EMDR. Kathleen M. Martin LICSW also developed an amazing Readiness Checklist for Phase 4 of EMDR that I use as an invaluable resource.*
So, first we are looking for a strong therapeutic alliance where young people feel safe enough to be honest and truthful about the EMDR process. For young people who are typically not voluntarily signing up to do trauma work (as adults are) and are brought in by a parent, it may take a longer period of time to build the therapeutic alliance.
Next we consider if we as therapists have a thorough enough history of the presenting problem, negative cognitions, and themes. We need to have a clear understanding of the order of progression through the trauma targets and also identify if there are any secondary gains that need to be identified and addressed.
As Play Therapists we can gather rich information and data from non directive forms of Play Therapy such as Child Centered Play Therapy. By understanding themes in the play we can develop hypotheses about how these themes relate to their Negative Cognitions for EMDR work.
Next we look at stability, which is so essential to consider for young people. Young people may be going back into a significantly chaotic, traumatic, or abusive home environment which may not be supportive of trauma work.
Or there may be other environmental factors that would indicate putting a pause on trauma desensitization and reprocessing work such as a teen just breaking up with a partner, a child losing a family member, parents announcing a divorce, a large test coming up, or any other sort of destabilization or stressful events that would be negatively impacted if the child were dysregulated from trauma reprocessing.
Also consider other timing issues such as therapist or client vacation or extended periods of absence. We want to make sure that we are available to our clients during Phase 4 of EMDR and there are not going to be any extended periods where a client does not have access to their therapist. Another issue to consider is if a client has difficulty with consistent attendance. This is one of my big factors for beginning trauma work with children, because if they are missing 1-2 or more sessions per month our trauma processing will not be consistent.
We also want to screen for dissociation unless you are specifically trained and have received consultation in working with EMDR and dissociation. My go to screenings are the Adolescent Dissociative Experiences Scale-II and the Child Dissociative Checklist - Version 3, which is a parent report for younger children.
So if all of those factors are met then we look at the activities we are doing with clients in sessions. First we need to make sure that young people have an age appropriate idea of what EMDR is. We also need to make sure that young people have all their questions answered about what EMDR might be like.
Oftentimes parents get the longer more in depth explanation and younger people can have a shorter and simpler explanation or a metaphor. We also want to make sure parents have a clear understanding of what symptoms may be like after reprocessing and how to support their child after a trauma session.
There also needs to be some familiarity with the materials and types of scaling questions that will be used in Phases 3-6. For example we don’t want the first time a child uses the sand tray to be the first time they enter Phase 4. This new type of material or activity can actually create a neuroception of danger which is contraindicated for starting Phase 4. We also want young people to have ample time to experiment with different kinds of Bilateral Stimulation (BLS) to get used to what type feels best for them.
During the preparation phase we also want to make sure we are playing games and engaging in activities that label feelings, increase emotional literacy, use scaling, and help identify body sensations. If young people are not able to stay within their window of tolerance, have dual awareness of the past and present, or cannot engage in state change from dysregulated to regulated (both in and out of session) then more preparation phase work is needed.
We need to make sure that young people have access to feelings (not over accessing or repressing), can label them, can identify the level of feeling, and can connect to their body sensations before moving forward.
Again, if you are nodding and all of this looks good and seems right then it is likely that a child is ready to enter Phases 3-8 of EMDR. You know your client best and ensuring factors for readiness are met, reliance on your training, and using your clinical judgement is key to make the official decision.
If you are still unsure then you can start with an easier or “softer” target to see how young people handle the BLS and reprocessing. This may be a milder trauma target or a present day trigger.
What else do you look for as a "green light" for trauma work? Drop a comment below!
*If you google this description you can easily find the Readiness Checklist for Phase 4 of EMDR sheet Kathleen M. Martin LICSW also developed. It is not hosted on a website and clicking on the link lets you automatically download the word document.
Combining Eye Movement Desensitization and Reprocessing (EMDR) and Play Therapy is one of my most favorite ways to work with young people!
If you don’t know about EMDR, it is an 8 phase model of therapy for the treatment of trauma developed by Dr. Francine Shapiro. As an EMDRIA Approved Consultant I love to talk with other therapists about how engage children in trauma work combining EMDR and Play Therapy techniques to make EMDR for children developmentally appropriate.
I wanted to share the top 5 things you need to know about working with children, trauma and EMDR if you are thinking about getting trained in EMDR, or are already trained but aren’t quite sure where to start.
EMDR Treats Trauma
EMDR is based on the theory of Adaptive Information Processing (AIP) which asserts that psychopathology is due to memory processes of maladaptive encoding and/or incomplete processing of life experiences that are traumatic, disturbing, or adverse.
This freezes the trauma in a state-specific form (with all the sights, sounds, tastes, smells, physiological reactions, and body sensations) in its own neural network, which makes it unable to connect with other memory networks that hold adaptive information.
So, for example, when someone who is the victim of a dog bite comes into contact with a dog (a very lovely safe dog), they are not able to have an understanding (linking to adaptive information) that they have met a TON of safe and loveable dogs and only one dangerous one.
Instead the frozen, maladaptively encoded, and incompletely processed neural network of the trauma is activated by the trigger of seeing a dog in the here and now and now all dogs seem extremely dangerous and the body begins to have a trauma response.
When someone is triggered, the past (frozen neural network) becomes present. This maladaptive encoding and/or incomplete processing impacts one's ability to integrate the experiences in an adaptive manner. The very real threat of the dog in the past feels and experienced the exact same way in the present.
Through the 8 phase model of EMDR a three pronged approach is used to target the past, present, and future.
EMDR facilitates the resumption of normal information processing and integration by desensitizing the trauma and reprocessing the trauma memory to link up the frozen neural networks to networks that hold adaptive information.
SO COOL. If you are curious about EMDR you can learn more it HERE!
EMDR treats “small t traumas”
When I was a bitty baby therapist and first started out in the field I heard the notion that most kids that present for therapy have some form of trauma, annnnd I couldn’t quite wrap my head around it.
The majority of my intakes weren’t endorsing events like major car crashes, domestic violence, traumatic weather events, or physical or sexual abuse. At the same time I want to take great care to express that there are many things that clients don’t disclose, for many reasons, at intake that are happening in their lives or have happened.
And in my practice today? It is very rare that someone comes into my office that doesn’t have some form of trauma.
Wait…. Did I get a whole new caseload? Start working at a wildly different practice?
My definition of trauma changed as I learned more about the neuroscience of trauma and theories such as Adaptive Information Processing. As I have used the powers of Play Therapy and EMDR to treat a wide range of traumatic events I have seen the transformational change reprocessing and integrating stuck and unprocessed memories has on functioning and level of symptoms.
When we can stop chasing behavior and get to the root of the difficulties (ie a likely memory stuck and frozen in the neural network getting triggered by something in the present, causing the past to be present) the behaviors are no longer necessary.
This is because the trauma doesn’t feel like it is happening in the here and now when a child is faced with a trauma trigger. When we think about current behaviors as adaptive given how the body is remembering and experiencing the trauma when triggered - the behaviors make sense.
And it makes even more sense knowing that some trauma memories can trigger implicit memories (ie a "felt sense", somatic, or emotion memory) not just explicit (ie the things we consciously remember - pictures, sounds, tastes, etc.). This means that young people may FEEL a certain way (triggered, scared, unsafe, angry, sad, etc.) but aren't able to consciously connect it to a past trauma or trauma trigger.
Trauma comes in all forms, and Dr. Shapiro differentiates big “T” trauma from small “t” trauma. She notes that Big “T” Trauma includes events that caused actual or threatened injury or sexual violation. Shapiro states that Small “t” Trauma are events that are emotionally distressing.
She states that both Big “T” and Small “t” Trauma can both have comparable long lasting negative effects and can become the basis of current dysfunctional reactions or mental health difficulties.
So, through training and experience I have witnessed the painful long term effects of events such as bullying, becoming ill when separated from a parent, parents minimizing, yelling, or name calling.
And, I see the transformation that can happen once these memories are linked with the neural networks that hold adaptive information. So given this information - if you see kids there are definitely a wide variety of young people that will walk in your door with both big “T” trauma and small “t” trauma that can benefit greatly from this approach!
EMDR needs to be done by a therapist fully trained in EMDR
Hopefully this one is given but I wanted to detail out what the process is for being fully trained in EMDR. EMDR International Association (EMDRIA) has outlined the criteria for someone to be fully trained in EMDR. Usually this training is 40 hours long as well as 10 consultation hours on your use of EMDR with clients.
There are some programs out there that will do an introduction EMDR program in a day, books that you can get, or other ways that you can become familiar with EMDR. However, I truly believe that being trained fully by an EMDRIA accredited program is not only a good idea but also ethical and necessary!
So you are either one of two people - you know all about EMDR and are fully trained and totally are picking up what I am putting down OR you know a little bit about EMDR or maybe nothing at all. If the latter is you, you can check out how and where to take this amazing training HERE!
Annnd if children are a large part of the population you see there are trainers that specialize more in working with children, so seeking out someone with this expertise for your initial training could be something to consider!
Children benefit from EMDR
I can’t tell you how many professionals I run into that were fully trained in EMDR with little to no training on how to adapt the protocol to use in their work with children. And I get it, there is SO much information to cover about trauma, AIP, and the EMDR protocol that when you put in some demonstrations, time for practice, and trying to highlight special topics there is not much time left for anything else.
BUT because of this some draw the conclusion that it can’t really be done with children. OR it feels really cumbersome and complicated to translate the 8 phases into something that doesn’t feel too scary, overwhelming, or inappropriate developmentally for a young person.
So here is why I think it is absolutely necessary to do EMDR work with children (who are a good fit of course)- first looking at the neuroscience of trauma!
Neural circuits that are used over and over are strengthened. The saying “neurons that fire together wire together” by Donald Hebb is absolutely true. It is also a “use it or lose it” kind of thing. So - neural circuits that are not used are dropped or pruned.
There are two waves of branching and connecting that are followed by a reduction and pruning - ages birth through three and ages 11/12 years old. So what this means is trauma that occurs in childhood can actually hardwire in a fight/flight/freeze trauma response rather than wiring for prosocial connection and engagement.
If we can heal trauma before these crucial periods of neural cropping it sets children's brains up for success in their later teens and adult life.
AND because children have less dense neural networks (ie less memories, experiences, connections) they actually process faster than adults!
Furthermore research has found that EMDR can be used effectively with children four years old and up to treat trauma symptoms. And apart from the pages in a research journal I have seen this firsthand, and it is AMAZING!
Kids can get it, they can engage, and they can do this hard work!
EMDR must be adapted to use with children
Most children need minor to significant adaptations to the standard protocol to be able to work through the 8 phases of the protocol. And typically the younger the child the more adaptations may be needed. And, to be honest if you ask a 5 year old to focus on any one thing while just sitting still you are not likely to be successful, especially with trauma work.
EMDR and trauma work with children can be fun, engaging, and done with cooperation and willingness. Usually this means games, sand tray, combining with Play Therapy, bibliotherapy, or any number of different interactive activities.
EMDR with children also means shifting how we administer Bilateral Simulation (BLS) to make it fun and engaging and being more visual with how to scale SUDS and VoC. It also means having a longer Phase 2 Preparation to get young people used to the materials they will be using and tasks they need to engage in during the desensitization and reprocessing phases.
Now, your question might be - what next? How do I get started? I always suggest getting extra training from an EMDRIA CE provider who works with children as well as seeking out consultation with someone who specializes in working with kids.
I also wanted to share my three favorite books to help you start to begin to put it all together! The first is from Ana Gomez - EMDR Therapy and Adjunct Approaches with Children: Complex Trauma, Attachment, and Dissociation. Ana takes you through step by step with the specific activities, games, and techniques she uses within the 8 phase model.
Next is the book EMDR With Children in the Playroom: An Integrated Approach by Ann Beckley-Forest and Annie Monaco. This book does an excellent job of how to integrate EMDR with a prescriptive Play Therapy approach and use bilateral stimulation within Play Therapy.
Lastly is Small Wonders: Healing Childhood Trauma with EMDR by Dr. Joan Lovett. Dr. Lovett applies a storytelling modeling of EMDR for work with younger children.
Now what about you? If you are EMDR trained and work with children what do YOU want therapists to know? If you are thinking about getting trained in EMDR what questions do you have? Leave a comment below!
Have you ever had a client walk into session, SO EXCITED, holding one of their prized possessions from home? They have been thinking about your session for DAYS and even put their toy right by the door so they wouldn’t forget it before they left!
Well...if that has never happened to you in office it has most definitely happened to you while doing Tele-Play! I mean, for most kids (even if they have a Play Therapy Kit) they definitely want to use their toys too during play.
So...um...how do we approach this? Does using toys from home in Play Therapy matter either way?
Well...the answer to this, as with most things, is - it depends!
Let’s start with theory. Depending on what theory you are working from might hold a lot of clues to how to approach this. If your theory states that the therapist will be selecting all the toys and deciding how they will be played with then there might be some more rules or restrictions. OR if theory only restricts to certain specific toys and activities then let theory lead the way!
If we look at Child Centered Play Therapy, Dr. Garry Landreth’s text Play Therapy and the Art of the Relationship has one general rule, which is only allowing items in the playroom that you would normally select for the playroom.
Not so sure what that means? This article HERE from the University of North Texas does an excellent job of spelling out criteria for selecting toys and materials, highlighting the three categories of toys, and giving a sample list of a fully equipped playroom.
So long story short - the dinosaur, baby doll, race car, or lego ship are totally invited in to play. The Xbox or DS? Not so much.
My take on this is that if children think about, in advance, their time with you and are planning out what they specifically want to do, whatever they bring has special meaning, purpose, and intention. AND could it be that that they have a special theme they want to express that they aren’t sure you have a toy that would exactly cover it?
Because of this rarely do I not allow a child to bring into the Playroom and engage with a toy they have brought from home.
I usually say something like “I see you brought something special from home”. Then they usually tell me what it is and what they would like to do with it.
From there I set some structure and say something along the lines of “Well I want you to know that what you bring in with you must leave with you today! Your dinosaur would be pretty lonely if he had to hang out with me for the rest of the week until I see you next!”
This statement can be especially important if a client brings in a toy that is similar to yours (ie a lego character or miniature) to really make sure that they are leaving with all of their belongings. I have also had young people bring in the EXACT same miniature of something I have! It gets a little trickier from there - but OH what a treasure trove of potential themes!
Now one of the things I appreciate about toys from home when doing in office therapy is the space that is naturally created and distance from the play theme as the client leaves the office. They stop playing, gather their things, head to the waiting room, take the elevator down to the parking area (at least in my office!) and have a car ride home before the toy can be really played with again.
This creates some distance and safety from the play themes they have been working through in your office. The danger with toys from home in Tele-Play Therapy is that the camera will shut off, the client will continue playing out the play theme without the support and containment of the therapy process AND someone will walk in.
Maybe it’s a brother that completely takes over the storyline of the play. Or maybe a sister teases and makes fun of the toys or story. Maybe it is a parent who is frustrated if there is a mess, they didn’t do their homework, or the way they are playing with the toys.
Here lies the danger that these dynamics are going to come in and affect a play theme and the processing that has just been done. SO because of this I am a HUGE fan of creating a bin of toys that the client only plays with during Play Therapy sessions and then returns to the bin together at the end of the session creating containment (either the client or parent).
However, there are some young people that can’t afford or do not agree to having a separate toy bin. For these clients I also think there is some benefit from creating an intentional clean up time and space from the toys for at least a little bit. Maybe to get a snack, maybe play outside for a bit, or play with some other toys before coming back to the toys used during therapy.
What about you? What does your theory say about toys from home? Drop a comment below!
Everyone needs a rainbow! Even on a cloudy or gloomy day we can always cultivate a rainbow from within.
The metaphor of a rainbow is so powerful – the bright beautiful colors after the storm. Hope, healing, acceptance. Sometimes it can be a symbol of better things to come. You know, somewhere over the rainbow! Oh, and don’t most rainbows have a pot of gold at the end?
So considering all of this pairing rainbows, breathing, and mindfulness seems like a winning combination!
I want to share three ways to use rainbows for mindfulness and deep breaths! The awesome thing about these activities is that they all have printables that you can use for directive play therapy in office OR email to clients if you are doing Tele-Play!
Rainbow Bubble Breathing
This breathing exercise is fantastic for smaller children or those new to deep breathing. One large bubble is used to symbolize a deep breath in and two smaller to symbolize slower smaller breaths…for all the colors of the rainbow! Grab the free download from the Branch Habitat Blog!
Dawn Selander shares her printable for her rainbow meditation for kids! She has a characteristic that goes with each color (red = physical, orange = emotional, yellow = personal, etc.) and provides a meditation script that goes through the entire rainbow. The concepts and language are great from preschoolers up to teens!
This printable from Monkinya has children trace and breathe in a color and breathe out worry for all colors of the rainbow. This is an excellent activity for Cognitive Behavioral Play Therapy where you are shifting cognitions, putting the difficult thoughts out of your mind, and being intentional about what thoughts occupy your brain!
So there you have it! Three ways to use rainbow breathing in your therapy practice!
What about you? Do you have any rainbow techniques that you like to use in your practice with children? Drop a link or comment below!
Looking for more resources for regulation? Check out my training on Keep Calm and Regulate On: Play Therapy and the Neuroscience of Emotional Regulation!
Your Play Therapy theory guides you on the “what” to do in the Playroom - what you should say or not say. What toys are present or absent. Who makes the decisions about what happens in the Playroom. If and when parents come to play.
AND beyond what we do in the Playroom how we show up in the Playroom is equally important if not more important. What I am talking about is about creating a neuroception of safety in the Playroom. Neuroception is the process of neural circuits determining if a certain situation is safe, dangerous, or a life threat. If a child perceives us or our Playroom as dangerous or a life threat all that theory and technique goes out the window.
In this blog HERE I talk about creating a neuroception of safety via Tele-Play and dive a little bit deeper into neuroception and co-regulation. Well...what about when we are in the office?
Some of the ways of creating a neuroception of safety over virtual platforms are pretty similar, BUT we do have a different nervous system experience when we are sharing the same physical space.
Before we dive into cues of safety let’s get clear on what our nervous system nerurocepts as dangerous. Lisa Dion identifies four threats to the nervous system in her book Aggression in Play Therapy. They are:
Okay - now that we know what the body perceives as dangerous or threatening here are my top tips of how to create a neuroception of safety in your Playroom!
Create Structure and Consistency
“Trauma is chaos – structure is healing” is one of my most loved phrases from my Trauma Focused Cognitive Behavioral Play Therapy training. Because it is SO TRUE. I talk about this concept extensively with parents when working on how they can support their child at home.
BUT this is really true when it comes to our Playroom too. We need to create structure for our session so young people know exactly what to expect each time they see is. In her book, Lisa Dion also refers to “the unknown” as one of the four threats of the nervous system. With creating structure we are making the unknown known.
When it comes to the Playroom this means giving consistency and structure down to the little details of how you start your sessions - parent check in, right into the play, or checking in in some other way. It also includes starting and ending at a consistent time.
In Child Centered Play Therapy this also comes with the entry to the Playroom statement and the warning for session closure. The biggest victory? When the child can repeat verbatim your entry to the Playroom statement or comment on how it is the same every time.
Predictability creates safety.
It also means sticking to the structure you have set up. If you are structuring a Child Centered Play Therapy session it doesn’t mean half way in asking questions and transitioning into a talk therapy session or a directive Play Therapy session.
Also - how do you say goodbye? Is it the same every time? Some therapists even get so predictable they wear the same exact thing every day. Although I can’t manage that I do have a work “uniform” that consists mostly of leggings, a dress, and a sweater (hey - a girl has to be comfortable right?).
Send Social Cues of Safety and Co-Regulation
This Co-Regulation Quick Guide from Justin Sunseri is fantastic! He talks a lot about “safe and social cues” as the foundation for creating a neuroception of safety.
When you are in the Playroom I think the most important safe and social cues you can give are:
If we are not present and we are out of our window of tolerance our clients will feel our nervous system energy and also become dysregulated. It sends them a cue of danger that something in the environment may be dangerous or off - even if it is just you preoccupied with an unanswered email, a phone call you just made, or a stack of notes.
So figuring out what you need in between sessions and during sessions to regulate your nervous system so you can be the best version of your therapist self. Lisa Dion is fantastic at emphasizing the importance of connecting to and feeling your body as well as discharging nervous system energy through body movement during sessions. This might mean swaying and moving during your time with the child.
And outside of session? Regulating yourself might mean eating something crunching between sessions, stretching and going for a quick walk around the office, or deep breathing and meditation exercises. Maybe what you need is co-regulation and to pop over to the office next door to connect. The great news is there is a gigantic buffet of regulation skills options out there – find what works for you!
And what if we can’t be regulated? Well, then it is essential to be congruent! Congruence is the ability to be real, open, authentic and integrated during sessions. This is also what Carl Rogers would refer to as genuine – a core condition of therapy!
The opposite of congruence? Incongruence- another cue of danger! Lisa Dion has an excellent blog post HERE about the importance of congruence as a Play Therapist.
Essentially the importance of authentically being yourself and showing up as you are because when we are “faking it” - kids know. They can sense something isn’t right even if they aren’t able to quite put their finger on it. Sometimes they make assumptions it is them, their play, or they can be led to feel rejection. All of these? Well they are working against your therapeutic goals.
So overall it is best for us to show up as we are and be authentic as ourselves.
Want to go deeper? Check out this article by Dee Ray, Kimberly Jane, and Hayley Stulmaker from the International Journal of Play Therapy!
Be Mindful of The State of The Playroom
Okay, we have all had those sessions. The sessions where our shelves get wiped out and nearly every toy ends up in a pile on the floor. Creating safety for our clients also involves making sure everything gets put back in a consistent spot and the Playroom looks pretty much the same every time they enter. They know where to find the dolls, the trucks, oh...and the handcuffs!
Things should also be placed in a neat order so the nervous system isn’t overloaded. More things to scan and clutter means the amygdala is working harder to scan for safety and danger.
This also means having a good hard look at your desk. If you have a hybrid office where your desk is also a part of your Playroom or play space making sure there are not 1,000 post-it notes all over, stacks of paperwork, or 50 coffee cups.
Lastly there are certain colors (like red) that can be activating to our nervous systems and other colors that can soothe. Pictures or art that is activating can put us into a heightened state of arousal. Pictures of nature or water or elements of nature like plants, flowers, or a fish tank can all create a neuroception of safety.
And that’s a wrap! What are your tips for creating a safe Playroom? Pop them in the comments below!
Looking for more resources for regulation? Check out my training on Keep Calm and Regulate On: Play Therapy and the Neuroscience of Emotional Regulation!
Deep breathing is definitely one of the quickest and most efficient and effective ways to regulate your nervous system. If you want to learn more about some fun ways to incorporate deep breathing into your Play Therapy sessions check out this blog HERE!
BUT for some young people deep breathing isn’t their jam… and that’s ok! I wanted to offer some alternatives to deep breathing for emotional regulation for young people you work with!
When we become dysregulated and our sympathetic nervous system begins to take over we produce stress hormones including the fast acting adrenaline and longer acting cortisol. These hormones can lead to anxious or depressed mood, stress, and fatigue.
Exercise or moving your body can be a regulation superpower. First, it helps reduce the stress hormones levels in your body and it also produces endorphins which are our natural painkillers and also boost mood.
Soo...does this mean that we should tell kids to do push ups when they are anxious or angry? Well...maybe? I mean if they like pushups sure!
Really it is any way they want to move their bodies - a bike ride, jumping on the trampoline, a dance party...all of those are good options! You can get some movement in during the session OR you can help brainstorm ways to create intentional periods of movement at home.
Progressive Muscle Relaxation
Progressive muscle relaxation is a technique where you progressively tense and relax the muscle groups in your body paired with controlled deep breaths in and out.
One of my favorite Progressive muscle relaxation is done by pretending you are doing silly things as you tense and release your muscle groups. I learned a version of this script HERE in a Yoga Calm training and kids LOVE it! You can squeeze your hands like squeezing lemons, stretch your arms out like you are a cat, and pull your head and shoulders in like you are a turtle. I also love to “shake it out” with a whole body shake in between each animal!
Another favorite of mine is this Melt Away relaxation script. Here you imagine the sun shining down on each muscle group and imagine all the tension melting away. They give ideas of what your tension is melting away like as snow or butter...however with all the muscle groups it can get a bit repetitive. I also like to have the tension melt away like ice cream, a snow cone, or ice.
As a Cognitive Behavioral Play Therapist I truly believe that the messages that young people say to themselves hold such power over the way they feel and what they choose to do next.
Sometimes kids get really good at shifting the messages they are giving themselves, but other young people….need help! Check out this FREE download of 15 printable affirmations for self regulation HERE!
Some of my favorites? I am safe, I have choices, and I am loved. Repeating these affirmations with breaths can create a felt sense of safety and significantly helps with regulation!
Mindfulness is the intentional practice of bringing attention and awareness fully to the present moment without judgement. This allows us to break away from self-judgement that often leads to dysregulation.
This video HERE has a great explanation of mindfulness and it is kind of funny too. Full disclaimer - this is probably not a great video for younger children. It..well...it uses the word pissed. I know it’s pretty edgy. BUT it does have a unicorn and rainbow scene so that makes up for it right? Maybe just for you, or for some of your teens.
OK if you are looking for a video for younger children check out this video HERE! OR anything by Cosmic Kids Zen Den!
Some of my favorite mindfulness decks for kids are the Monkey Mind Meditation Deck and the Mindful Kids cards. Looking for a freebie? Check out the 20 Mindful Moments Cards from Sanford Health.
Now it’s your turn! Comment below with your favorite non-breathing techniques for regulation!
Looking for more resources for regulation? Check out my training on Keep Calm and Regulate On: Play Therapy and the Neuroscience of Emotional Regulation!
Nearly all young people who come into our offices have one thing in common - difficulties with emotional dysregulation.
Some (and I would argue nearly all - but that is a topic for a different day) come in with traumatic experiences (of all sizes) that have shaped their nervous system to be more easily triggered by certain things, situations, or stimuli. They have an oversensitive amygdala that, although it has good intentions, is often hypervigilant for cues of danger.
This leads to difficulty with regulating big feelings like sadness, anger, stress, or anxiety. And then some of the young people we work with go in the complete opposition direction. They are restrictive, where they spend a lot of time repressing and pushing emotions down. These are the kids where we spend our time getting them to “feel the feelings”.
But all of them, with your support, need to find their “just right” of regulation. Like in Goldilocks and the Three Bears - not too much, not too little, just right!
So with this comes the first truth about emotional regulation - It’s ALL about regulation!
In your work in supporting young people on their journey of “just right” I wanted to share these other three truths you might not know about emotional regulation.
Regulation Doesn’t Equal Calm
Now, calm might be the ideal! We feel at our best when we have what I call “comfortable feelings”. However, we can be regulated within our sadness, our anxiety, and our anger. Connected to ourselves with our prefrontal cortex in charge. BUT don’t take my word for it - listen to Lisa Dion as she talks about it HERE!
One of the first times I heard her talk about this, some major things clicked for me. The truth that feeling and experiencing our feelings is so important, and while it is most comfortable to be calm, the real goal becomes regulated enough to have control and widen the gap between feeling and action.
Not All Regulation Breathing is the Same
Deep breathing is undoubtedly one of the quickest ways to engage the vagal break, slow the heart rate, bring us back into connection with self and help re-engage the prefrontal cortex.
However, did you know that some breathing is meant to slow the heart rate and some is meant to increase heart rate? And BOTH are for regulation?
Okay - so the deep breathing we usually teach our clients usually has a longer exhale than inhale. When I teach deep breathing I usually teach 4 counts in, hold for 4, and out for 8. This type of breathing slows the heart rate and brings us from hyperaroused (fight/flight) back to regulated.
However if someone is hypoaroused (collapse/shut down) you actually want to flip it and breathe in for twice as long as you breathe out! So this might look like breathing in for 8 and out for 4. With this your heart rate increases, bringing you out of a depressed/shut down state and back to regulated!
Self Regulation is Internalized Co-Regulation
Allan Shore’s work (you can read some of it HERE) goes really deep into the neuroscience of attachment. What’s fascinating is that the attachment transactions between mother and baby are actually imprinted in implicit procedural memory creating enduring internal working models for coping strategies and affect regulation.
SO this means that the way that we self-regulate is actually an internalized model of how our attachment figure co-regulated with us. This highlights the importance of working on strengthening the attachment relationship!
Robyn Gobbel actually goes as far to say that self regulation doesn’t exist! See what she has to say HERE!
So there you have it! Four truths about emotional regulation that hopefully will help you think a little more critically or have a bit of a different lens when you are doing the hard work of helping the nervous systems of the young people you work with regulate more effectively.
What about you? Share your truths about regulation below!
Looking for more resources for regulation? Check out my training on Keep Calm and Regulate On: Play Therapy and the Neuroscience of Emotional Regulation!
I'm Ann Meehan, an LPCC, RPT-S, and EMDR Consultant. I help other therapists grow in their passions as play therapists, trauma therapists,and child and adolescent therapists.