How Complex Trauma Impacts Play Therapy Timeline

How many sessions “should” a child need in play therapy? 
 
The only correct answer to that question is “it depends”.  According to research HERE it takes an “average of 20 play therapy sessions to resolve the problems of the typical child referred for treatment”.

So real talk? This is actually quite rare in my practice. Check out more about the 12 factors that contribute to prognosis HERE! 
 
A couple of major determinants for the children that I see that are in and out of therapy in about 5-6 months-ish are a strong attachment history, parents who reside in the same house, and have an effective parenting relationship.  These children often tend to have shorter term symptoms (think anxiety that has been present for 4-5 months rather than 3+ years), an environment that meets their basic needs and is safe, and no trauma history.  For these kids life is typically stable (with no history of multiple moves, deaths in the family, or life stressors). 
 
Now it goes without saying that this is in no way a foolproof formula and there are plenty of children who have other backgrounds or histories that may progress through therapy at a quicker pace AND there are children who display the traits and characteristics above who may have a longer course of therapy. 

And for families that are divorced or separated,  often this is the best choice for the family given the level of conflict or dysfunction AND at the same time the reality is divorce is considered an adverse childhood experience or an ACE. Children often have high levels of stress transitioning from one household and set of rules to another. Families can buffer this by having excellent co-parenting strategies, however high conflict co-parenting is a reality for many families. 
 
One of the biggest factors of length of service is the background and history of the children and families that come into your practice. And based on the types of therapy that I am trained in, I often have children with trauma histories that are referred to my practice.
 
And trauma? Well… that often means a longer timeline of therapy.   
 
The short non-technical answer for this? There is a lot more to unpack with trauma. 
 
Let’s think about it.  It’s all about memories and experiences.  Many theories (including Cognitive Behavioral Therapy and Adaptive Information Processing) state (in some way or another) that memories and experiences form a “template” of how to respond to experiences in the current moment.
 
Going further it’s not just the memories, but how they were encoded and what it led the person to believe about themselves.  

Consider this (completely factitious) child with a complex trauma history where their mother had postpartum depression and had difficulty with co-regulation in infancy leading to the baby having difficulty being soothed leading to the development of anxious attachment. Then maybe this child moves 4-5 times by the time they are about to start Kindergarten.  
 
One of the moves was because there was a fire in their home. About the time of the first move their grandmother passed away who was their primary source of daycare. After this their mother has to quit her job to provide childcare because the child’s father has a job that requires him to work long hours and often be gone overnight. This leads to financial insecurity, however is a more financially feasible option than placing the child in daycare. The child’s mother sinks into a depression, and although she is providing primary childcare, has difficulty getting out of bed for a period of 6 months. 
 
This child may have developed mental health symptoms in infancy and separation anxiety so severe that by the time they go to kindergarten they may have major school refusal. This (again totally factitious) child likely has a neural network of thousands and thousands of memories and experiences where the world was not safe and did not meet the child’s needs.
 
Think about the course of therapy for this child vs. a child who has a strong family support network, secure attachment, has all their basic needs met, financial abundance, and has lived in their home since the day they were born. The most difficult experience in this child’s life was when their family dog passed away when the child was two (which is still very upsetting and difficult!).  This (also made up) child may have developed some separation anxiety due to having childcare with their aunt and three cousins and this is their first experience being with non-familial children and caretakers. 
 
If we hold these two cases side by side we can predict that there is more therapeutic work to be done to “excavate” and heal the thousands of memories and experiences of trauma with the first child vs. the second child where the difficulties are short term and there is a strong memory base of safety and getting needs met.  
 
This is one of the most important lenses we can use to evaluate and estimate length of treatment for a child AND prime expectations of progress for ourselves and for parents. 
 
Want more support on working with trauma and play therapy?  Check out these four amazing courses below to help you work with kids with trauma! 

This was the absolutely short version BUT if you need more support with working with trauma in play therapy check out my course on Child Centered Play Therapy: Troubleshooting the 13 Biggest Stuck Points! Child Centered Play Therapy is an evidence based treatment for trauma - up your CCPT game by busting through the most common stumbling blocks and struggles! 

Looking for more resources and support around play therapy themes and trauma?  Check out the training Dinosaurs In The Dollhouse: Interpreting Themes in Play Therapy  and learn the 7 frameworks and tools to interpret play themes with TONS of case examples! 
 
Want to know more about trauma, regulation, and attachment? Check out my training on Keep Calm and Regulate On: Play Therapy and the Neuroscience of Emotional Regulation to get you ALL the information you need to dive deeper with your clients into all things regulation! 
 
If you are trained in EMDR check out Playing Through Phase 2: Combining Bibliotherapy and Play Therapy for Phase 2 of EMDR! 
 

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