Dear Therapists, 

My home state of Minnesota is hurting.  Black communities are hurting. This nation is hurting.  

I want to own the responsibility of having the privilege of speaking to child therapists through this blog on a semi routine basis. I want to use this platform to acknowledge the current state of our nation and my home state of Minnesota. I am writing this against the backdrop of days of protesting in Minneapolis and around the country for the senseless murder by police of George Floyd.  A father, a partner, a son, an athlete, a musician, and described by his friends and family as a beautiful spirit.

In all of this, I want to fully acknowledge my privilege - to turn off the TV, check out of social media, and not worry about my safety while living my normal life. I can drive my car, go to the store, be out in nature, and a million other things without worrying about my safety just because of the color of my skin.  

I am hoping that in all of this trauma, continued racism, unrest, heaviness, and darkness, we also will not let the dialectic of light and hope go unnoticed. Communities are coming together to clean the streets, board up buildings, provide free crisis counseling to those in need, and secure food and supplies for the communities affected. Communities are coming together to grieve.  Communities are coming together to heal. There is still much work to be done. It’s messy. It’s uncomfortable. AND let’s not also forget to honor the light.

To therapists of color and especially Black therapists, I’m sorry. I’m sorry for your pain, for your trauma, for your re-traumatization, for the reality of daily life in this country.  I am listening. I see you.

To my fellow White therapists being an ally is a verb. Acknowledging and understanding our privilege, attempting to understand racism, prejudice, and the experience of people of color is continuous.  It is our job, not the job of our friends, family, peers, and colleagues of color, to educate ourselves, learn, and act. We need to identify how to be stronger allies in dismantling racism and to be actively anti-racist. AND if you haven’t started in this journey you need to dig deep and ask yourself why.  The best time to start was years ago, but the second-best time to start is today, right now.  

Still don’t know what more you can do? Check out these anti-racism resources or this article.  Also if you want to help Minneapolis and surrounding Minnesota communities affected check out this resource list HERE or to donate to  Black-led, community-centered organizing efforts in Minneapolis check out a list HERE.

Now, as a therapist who sees children - if you aren’t a member already please consider joining the Facebook group “The Journey of Cultural and Racial Diversity in Play Therapy” run by Kadesha Adelakun, LCSW, RPT-S.  It is a wealth and knowledge of resources to help support clients of color. Also, check out these articles HERE and HERE that prove that it is never too early to talk about race and racism with children.  I would also encourage you to look through this resource list of 30 children’s books to help support conversations with children about race and racism.  Not so sure about how to start this conversation with clients?  Check out this guide from Elizabeth McCorvey, MSW, LCSW to stop hesitating and start the difficult conversations. 

I would also encourage you if it isn’t something you do on a regular basis – take stock of your playroom and tools you use in tele-play.  How many characters of color do you have in your miniature collection?  Books featuring characters of color on your shelves? Puppets in your collection?  Where are all of these placed in your office? When a client of color comes into your office what would their experience be like? 

Also, I know I am nowhere near perfect and these questions to consider and list of resources are nowhere near complete.  Drop a comment below with other resources you have or that are helpful to support clients of color within your practice! Let’s continue to show up for our clients, our colleagues, and our communities, continue to be an ally, and continue to promote anti-racism within our practice.
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One of my favorite things to do is to help new play therapists develop the skills, training, tools, and knowledge to begin practicing play therapy with young people.  One of the most often questions I get is about how to set up the playroom.  What toys should I get? Do I need everything from this giant list? AND the tricky thing is that some play therapists are juggling supplies and toys between multiple locations, schools, telehealth, or doing in-home therapy. 
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Now, with the shift to Tele-Play this has created a whole new level of stress about how to outfit each child with the right toys to engage in meaningful play therapy work.  Most of us don't have the budget to equip each child with all the toys and supplies that we all have in our play rooms!  And, as we imagine what it might take to go back to in office work we are grappling with worries and fears of how to support our client’s best and in a safe and ethical way by sanitizing offices, staggering appointments, and the way we sanitize our toys and environment. Additionally therapists are brainstorming about each child having their own kit or set of toys that only they play with to decrease any potential spread of germs. There are so many questions and decisions to make - masks or no masks? Cleaning between clients or separate play kits? Staggering appointments or still full on telehealth? What ARE the best ways to clean my toys?  Ugh - so much information that is constantly changing (because well....science) and from so many different sources, it is so overwhelming to conceptualize "what next?" 

How do we make sense now of what play therapy will look like for the children we work with when we return to the office - whether that is a month from now or 6 months from now?  Most will agree that the toys you have available depends on your theory and what goals you might want to accomplish with the populations you serve.  I also would argue that Garry Landreth's categories of toys (more on that here and here) , even if you are not a Child Centered Play Therapist, is a great list of the toys and items that may be helpful to understand what children need to process through and make sense of big emotions and life events.

However, in the midst of all of this I love to reflect on the teachings of  Lisa Dion's article here and podcast Lessons From The Playroom Episode 1 here,  where she (along with many other play therapists) argues that you are the most important toy in the play room.  It is truly the relationship with the child and our ability to hold space that is the most important thing about our time with young people. 

I also want to take this time to add that we need to trust the creativity and resiliency of children.  For children sticks, rocks, and even remote controls can become magical, wonderful, creative tools for rich, imaginative, and meaningful play. The remote controls and cogs above? Those are "families".  Yes - a mommy, daddy, and a little boy.  Well... at least to my little boy.  It warms my heart to see my son rocking,  nurturing, and patting the bottom of the "baby" remote or "baby mote" as he calls it. 

Knowing what I know about children, I want to use this space as a reminder that we don’t need every specific perfect toy – children will create their own worlds and express their needs through their imagination with what they have in front of them. 

I am taken back to my early days as a play therapist, which I talk about here, where I just graduated with my master’s degree, was working for a non-profit agency with no agency budget to equip play therapists and I had a tiny personal budget at best to equip myself with the tools for working with children.  So, I headed where most young play therapists head (and experienced therapists too!) – the dollar store.  I got a bazillion mini animal figures along with some other toys from rummage sales, donated by amazing friends and family who knew I was on the hunt for toys, and digging around in my own space to see what I could find.  What I came up with was a selection of toys that fit every category from Garry Landreth's categories of toys, but was a touch haphazard and a bit misfit.  To say it was a far cry from what my playroom looks like now is an understatement.

Even with these imperfect play therapy tools the children I worked with still did incredible and deep work.  There were nurturing families of frogs, epic battles with pool noodles, amazing art creations with crayons, and healing that occurred with less than perfect doctor kits. 

We may need to be flexible (like the noodle here) with our expectations of what this new landscape of play therapy may look like for those that are doing Tele-Play and as we dream of what going back in office may hold. 

The healing is within the relationships we create and hold with young people and inside the resilience and creativity of children.  

Drop a comment below (no client identifying info of course) with your experience of the resiliency and creativity of children!

Scavenger hunts are so much fun! It’s the excitement and anticipation of the what you might find, using creativity to find something that fits in the category, and the challenge of completing or finding all the items on the list. 

Now of course, scavenger hunts are not just something to kill time, they need to be grounded in theory and tied to the goals you are working on with the client.  Essentially – the golden thread!

However, what is so great about scavenger hunts is that they lend themselves to working on SO MANY goals and skills young people may be working on and most can be flexible enough to fit into a wide range of theories! AND the most important of those might be that when children are having FUN they are able to stay in their prefrontal cortex, in their window of tolerance, and this is where learning and growing happens! Wooo Hoo! And this is so important because the fun and joy we bring to our sessions allows us to connect with our clients and develop relationships, and research shows HERE that of the factors we have control over as therapists, the relationship is the number one factor for client change. Sit with that for a minute. 

Let’s talk about goals – depending on what and how you are hunting you may be working on mindfulness, self esteem, self talk or self statements, regulation skills, impulse control, rule following, or rapport building – just to name a few!  

There are so many interesting and unique ways to do a scavenger hunt.  I have found that sometimes the first prompt takes us to the end of the session even when the client has found all the items in under a couple of minutes! The processing about the items is so rich and because the client is in their own environment you get another window into their lives that you might not with other activities.

Now, what about the prompts? I’ve include a FREE download HERE of 5 different therapeutic scavenger hunts!  It includes scavenger hunt items and prompting and processing questions as well as a therapist guide.  Scavenger hunt topics include mindfulness and grounding, gratitude, nature, emotions, and self esteem.  However, this is the absolutely tip of the ice burg of scavenger hunts of what you can create for or collaboratively with your client! Below are some pro tips and extra layers of challenges you can add in to make things interesting! 
 
Pro Tips:

• A timer can help a client focus (who maybe would tend to wander) – kids LOVE to beat timers!
• If you are worried about a client’s ability to gather items you can assign it as homework (with parent assistance) to gather outside of session and do the processing during session OR have the parent as a “coach” to help gather during the session.
• Consider whether it is best for the client to “take you along” on a device or leave you stationary.  Considerations may be internet connectivity, a client who may need extra prompting during the search, or the portability of the device. 
• Connect with parents about any rules about what objects may or may not be taken – like maybe don’t take your teenage siblings phone for this challenge!
• Connect with parents about the boundaries – are some rooms off limits? Can the client go outside?

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Extra Challenges:

• Have clients describe the objects to you out of the site of the camera, and the therapist guesses the object.
• Set a time to beat for gathering all items.
• Set a goal for number of rooms to gather from (being mindful of the number of available rooms in the house).
• A rule that objects must all be the same color.
• A rule that the object’s main color must all be different.

 
Drop a comment to let me know if you have used scavenger hunts in your work (in office and in Tele-Play) with clients! How did it go and what are your best pro tips? 

Doing therapy as Tele-Play rather than in office therapy is a bit different to put it mildly.  Now, don’t get me wrong – there is beauty in connecting in times of crisis, supporting those we work with, and giving our best to serve our clients with what we have.

BUT one of the big things I have noticed is that for some young people our play is a bit more, ummm, stationary.  For someone who spends a majority of her professional life on the floor with young people, or up engaged in an epic battle or soothing a crying baby (doll of course - or maybe dinosaur?), the shift to sitting in a chair to make sure I am visible, on camera, and because my work space is a little small to say the least – it was a big difference for me to limit my movement! 

Now, I can be intentional and stretch and move between sessions but what about during sessions?  I want to share something that was born in one of my sessions that has been incredibly helpful for those energetic movers and shakers we work with.  It is called….THE SHAKE BREAK! *cue your favorite most body shaking music track here* 

There are definitely cues that young people may have that they need to get their bodies moving.  Maybe they are tuning out a  bit, or you can see them wiggling all  over the place, they are chewing their markers and pens, or a number of other things.  At this point you lightly introduce your observation of what you are noticing with their bodies and get curious if they may need to move.  Most of them will say yes and you explain to them that you would like to use Shake Breaks in your session.  This is simply where you take some time to shake out your bodies. 

As this becomes more part of your routine what can happen next is magical!  Either you or the young person will yell out SHAKE BREAK!!! during the middle of an activity and both get up and go wild – shaking all that energy out! 

The other awesome thing about this is you can use it to really dive in to what the warning signs were that their body needed to move and shake.  What were they noticing inside? How did they know it was time to move? It also gives them control over and practice in making decisions that are right for regulating their bodies.
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What other techniques and tips do you have for helping young people move their bodies in Tele-Play? I would love to know more about what everyone is doing so drop a comment below! 

I loooove me some pasta! Maybe it’s because I’m part Italian, maybe because it is a staple of so many wonderful memories, or maybe it’s because it is delicious.  I can’t be entirely sure.  BUT what I know is that it is not only useful if you want a delicious meal, but it can be useful in therapy too!

Now the pasta I am talking about is not a rigatoni, cavatelli, or farfalle.  No, it is one of those nice long thin pasta noodles – think of a spaghetti, angel hair, or one of my personal favorites – linguine! Most of us are familiar with using spaghetti noodles to connect young people with their bodies and work on relaxation.  In this exercise, like this script here, you ask the child to tense their body like an uncooked spaghetti noodle (noticing the sensations), and then relax their body to be like a cooked noodle noticing those sensations and the difference - all paired with breathing.

I have been using these delicious noodles to help young people learn more about the window of tolerance.  More specifically, how to we help young people identify and regulate through the distress to stay in their prefrontal cortex integrating both the emotional and rational/logical parts of our brain to make the best decisions we can in any given situation. Wheeewww – this is so much easier to describe with noodles!  

Now, how does pasta help us do this?  Well I am so glad you asked. Back to that nice long pasta noodle! When the pasta noodle is uncooked it is rigid with little flexibility.  When we put any pressure on it, even the tiniest amount – it breaks!  I use this metaphor to process what it looks like to be out of the window of tolerance and “break” – potentially anxiety, rumination, rigidity, inability to engage in perspective taking, anger outbursts, etc., all with the slightest trigger or pressure. 

I also talk to young people that you don’t want to cook noodles too long because they also get mushy, lose their shape, and break apart easily.  Pasta also actually loses taste and nutrients too!  We can process this like hypoarousal and the numbing out we can experience when we get into this state. Like mushy blah tasting noodles.  

Next you bring it back to that perfectly cooked al dente pasta noodle and process that these noodles have just the right flavor, are firm enough to hold their shape, but cooked enough to have flexibility.  This is the window of tolerance where we can handle and regulate through the ups and downs of life while still holding our shape.  Wiggly and flexible, handling whatever life can throw at us!  Here you can brainstorm what kinds of things help young people stay in the window of tolerance, handle distress, and stay emotionally and cognitively flexible.

The last step is my favorite part!  You process the experience of what the noodles look like in the boiling pot of water when they go from uncooked to cooked.  I like to think of it as the pasta dancing in the pot!  Then – with the client leading you come up with your pasta cooking DANCE! Yes – dancing like the cooked pasta in the water as a prompt and reminder to stay flexible! These dances are so fun, whole body, wiggly, flexible dances! 

​Bonus points for this activity if you actually have the energy to make some cooked pasta to bring in!!

​What are your favorite ways to teach emotional regulation? Any other foods that lend themselves to the window of tolerance?  Let me know and leave a comment below! 

Sometimes feelings get…all tangled up.  This can be confusing and sometimes we need help untangling them and sorting them all out.  Enter “The Color Monster” by Anna Llenas! This book is AMAZING and as I talk about here and here bibliotherapy is such a wonderful practice that is so adaptable to provide as a therapeutic approach in all sorts of settings – office, in home, at school, and of course Tele-Play!

This book is a wonderful story about a “Color Monster” who is full of mixed up colors and emotions.  A little girl takes the monster by the hand and gently helps the Color Monster untangle and separate out all of these feelings and put them into jars. 

The level of compassion in this book is SO wonderful.  One of my favorite things to tell young people is that feelings aren’t good or bad – they are just our bodies way of letting us know what is going on in the world around us!  For a lot of the littles (and teens too) that we work with there can be a lot of judgement that comes with anger and a portion of the therapeutic work can go towards decreasing shame about this real, normal, human emotion.  This makes sense as to why my most favorite line in the book is “Sometimes, you want to take out your anger on others.  But I’ll be nice to you, Color Monster, and your anger will disappear!”. My heart just melts on this page!

The book also emphasizes being able to feel and honor whatever feeling comes up and tell us that it is OK to feel all of these feelings, it is okay to listen to our bodies, and it is okay to cry! So powerful, especially for young people who often get flooded and want to repress feelings. 

Another thing that is just fantastic about this book is the use of metaphor.  It compares anger to a fire you might want to stomp out, sadness to a rainy day, and calm like leaves swaying in the wind.  If you are doing any sort of metaphor work with kids this is a GREAT book to get the wheels turning!
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When I am reading this with young people after I will pause, ask them what they noticed, and most of the time go into a Cognitive Behavioral Play Therapy activity about feeling identification and levels!  I have included a free download of these worksheets HERE!  I had so much fun creating these printables and thank goodness for all the Amazon packages I have been getting lately - there was no shortage of cardboard for this project!

So, after we read the book I have them select colors (up to eight - but let's be honest you could add more boxes and print a duplicate of the feelings jar page if you needed more) and color code and write in what feelings came up for them today or in the week using The Color Monster Check In download.  The book identifies five feelings of happy, sad, angry, fearful, and calm, but I wanted to make sure if other feelings came up there would be space for them so I included eight.

One thing to notice is how the feelings are being drawn.  As opposed to a color your heart activity (where the feelings are separate) the Color Monster’s feelings can be mixed up. Are some feelings darker (like pressed down harder when drawing) and what feeling are more prevalent? Do some feelings have just one line and are there obvious feelings that are missing? Do the feelings spill out of the color monster and onto the rest of the page?   These are all great things to notice and process along with how it feels in their bodies when the feelings are mixed up, any thoughts that might come up for the Color Monster, and the choices the monster may make when feeling all mixed up! Oh, it is also a fantastic externalizing technique! 

The next sheet is all about taking time to separate out and honor each feeling.  With the My Feeling Jar worksheet you can clearly identify each feeling experienced and how much of each feeling.  You can go deeper with young people and identify triggers, how they felt it in their bodies, warning signs of these feelings, and choices that might be helpful vs unhelpful to honor what is going on for them over the week. 

This exercise is also a great tracking technique.  If you engage in this activity with clients periodically how does their Color Monster change over time?  What about levels or ranges of feelings?  Does their emotional literacy increase where they could initially name three feelings, but now it’s five?    

Now, although this activity is for younger children, teens also have tangled up emotions too!  The teen version of this? This fantastic Tangled Ball of Emotions Download you can snag HERE from Sources of Strength. I have been using this drawing activity for a prompt of how teens feel currently and having them fill out a second for how they desire to feel.  From that point we can spring board off into processing how to get from here to there!
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Here’s hoping this activity brings you and your clients some superpowers to help untangle those messy, chaotic, and confusing feelings!  

The overwhelm from COVID-19 is real.  And the thing about COVID-19 is it's not just one thing - it's everything. I wanted to share one of the techniques I have been using with my middle schoolers and teenagers during Tele-Play sessions to help them try to make sense of the impact of COVID-19 on when it is SO HARD as adults to wrap our heads around. 

When I am doing a COVID-19 worry web, the session usually starts with a check in of how a young person's week is going.  When I can hear the overwhelm and exhaustion I will usually stop and ask them if it’s okay if I chart out what I am noticing as they talk. I usually use a plain white sheet of paper and pen and get to work! I haven’t had anyone say no at this point, but I guess if they did I would pivot and on to the next activity that would make sense.

As they start talking we brainstorm all the things that might be leading to the feelings of overwhelm, confusion, stress, exhaustion, the changes that have been happening in their lives, and things that they took for granted that they would do anything for now.  I have had SO many young people who really disliked school for one reason or another (social anxiety, bullying, learning difficulties) who are actually wanting to go back to the classroom. OR hated running errands with their parent - but now are craving to go to a store - any store - even the hardware store! How confusing is that for a young person? 

Usually I start with a circle in the middle (like the picture above) with COVID-19 inside.  The bigger categories I have found as young people are talking usually look something like this (but are definitely not limited to):

• ​Social Distancing
  • Schools Closed
  • Can’t See People
  • Stores Closed  
• Mental Health
• Illness

And from here – the sky is the limit.  The picture above is just a tiny fraction of what someone might have on their COVID-19 worry web (don’t worry this web is not based on any specific client). The ripple effect is enormous.  I have to social distance, so I can't go to school, and I can't see my friends, and I don't have their information so I have barely any social connections outside of my family.  OR I have to social distance so I can't go to school, which means my softball season is cancelled, and I can't participate in my senior year of sports so I may never play softball again.  So powerful. So much grief. 

After we have exhausted all the possibilities and connections, which a lot of the time takes up most of the session, I then hold up the drawing for the young person to see.  The final product looks like a less polished and put together version of the picture above, with scribbled words, smushed together bubbles, and frantic lines.  Usually we sit with the feeling in our bodies of what it is like to look at this web.  There is often first surprise or shock and then a settling into understanding.  Understanding of why they might be so overwhelmed, angry, want to cry, or just want to sleep all the time. It's a moment where they can reflect - "Oh I guess I do understand why I am feeling this way - it all makes sense now." 

We then process that sometimes with a big worry web like this we can feel stuck in the web, much like a spider web, and we can talk about what it feels like that every move we make or want to make is connected to this web in some way.  It’s so important to sit with the feeling of stuckness and honor it.

​Then – on to solutions!  How the heck are we going to get unstuck? And this my friends, is usually a whole other session.  Perhaps some reflective homework? Most definitely! 

I like to say that I was “born for the tray”.  I spent my childhood collecting actual sand from beach vacations, carrying pounds of it hundreds of miles home in backpacks on cars and planes (and through airport security), and collecting tons of knick knacks.  What a wonderful surprise when I found out that these knick knacks actually were something very valuable called miniatures and I would grow in my adult life to collect hundreds of them for my job!  And some of those knick knacks from childhood?  They sit on my sand tray miniature shelves in my office today.

When shifting to virtual sessions one of the things I have such a hard time transitioning was the power of Sandtray. There are so many great ideas for virtual technology trays like Virtual Sandtray but at $169.99 I had a difficult time committing.  Other therapists have gotten creative and used a Whiteboard App or Paint3D for free to create visual worlds with clients through screen share.

For me, while digital is an amazing alternative for still utilizing Sandtray with clients while you are engaging in Tele-Play, it was missing the tactile kinesthetic and sensory element that the sand and miniatures in office brings.  I wanted to share three ways for those who are not quite tech savvy or who are also missing the sensory and touch experiences of Sandtray to continue to support clients virtually.

Your Own Tray
For this option you literally use your own tray or portable tray and your own miniatures.  A major benefit to this is that the children you work with are already familiar with your miniatures and may find comfort, meaning, and metaphor in using miniatures that they previously used in office. 

You as the therapist manipulate the sand and select the miniatures and placement – all dictated by the child.  Joel Lambrides an LPCC and RPT from Minnesota shows an amazing video of how to set it up HERE!  He uses a brilliant fixed camera system (cell phone) that can be placed over the tray to create an aerial view. Another take on this would be a two camera system with a Telemedicine platform that could have more than one “client” where the therapist has both the phone fixed over the tray and another device to maintain eye contact and communication with the child. 

Draw Your World
I first talked about this technique HERE. For this type of Sandtray have the client or parent tape together four sheets of computer paper in a rectangle.  You can have the client start out by drawing what kind of ground the “tray” will have on the paper.  Will it be grass, rocks, lakes, rivers, mountains, or volcanoes? The sky is the limit! Then, do your sand tray work as usual adding in miniatures to tell the story and create the world.  I love this technique because it allows clients to be in control and touch, place, and re-arrange the world.  How do clients gather miniatures? Don’t worry – keep reading! I have you covered below.

“Sand” Tray
Okay – I saved my favorite for last! For those that know me know that I started out my Sandtray journey with a tray of corn. I have experimented over the years with other mediums besides sand to create trays and have enjoyed seeing the different dynamics that come out with each.  SO as I was brainstorming how to help clients get not only the movement and placement control (as with the technique above) I also wanted them to have a sensory experience of sand as well.  Do you know what feels kind of similar to sand AND most families either have on hand or can get for a reasonable price? RICE! Most families also have some sort of casserole pan or cake pan – thus the “Sand” Tray of a casserole pan filled with uncooked rice was born! Now – on to the miniatures!

Selecting and Creating Miniatures
Most clients have some sort of miniature collection in their house.  These could be action figures, toy soldiers, princesses, or if they are like me – knick knacks! I give clients a list of the categories of toys and encourage them between sessions to go on a hunt for minis.  I also assure clients that although it can feel overwhelming they really only need a couple of things for each category.  I encourage clients to get creative, go outside, and have an eye out for all things mini!

Now, there are definitely young people who would only be able to find a select few items in their home.  That is totally fine!  For these children we create!  You can spend a session having the client draw figures they want to be in their tray on paper, finding pictures from the internet to print out, or using stickers.  You can adhere pictures to small card stock rectangles (with a bit behind for support and a bit sticking out the bottom)  or small pieces of popsicle sticks to get them to stick in the sand. For some young people they may need the supervision and help of a parent for cutting out and pasting/taping.  For the young people that draw their world, create a flat base on the bottom with paper – like this genius method HERE! 

I created a free handout explaining the Draw Your World and “Sand” Tray technique that you can grab to share with clients HERE!
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What are your favorite ways that you have used the power of sand in the virtual world? Drop a comment below! 

As we are all adjusting to this new “normal for now” season of social distancing and sheltering in place it is important to get clear about how to support one another and regulate through these difficult times.  I wrote HERE about all the different response young people may have to COVID-19, which quite frankly was A LOT of different ways young people might react and process this pandemic.

So now you might ask – what next? What do we DO now (besides of course movie marathons)? I’m glad you asked!  Below are some ways I have been talking to parents, guardians, and families regarding how to support their children during this time!
 
Assess Knowledge and Give Age Appropriate Information:
Let’s ask children what they know about COIVD-19.  They likely know some things and this is a great way to open up a conversation and to be able to assess if they have accurate information OR if they have thoughts that are maladaptive.

These conversations can happen in therapy sessions or within family conversations.  There are some great tips for parents HERE and HERE for how to facilitate these conversations. One of the most important things to know is that as adults we need to manage our anxiety when talking through these difficult topics to create a safe space for kids to explore their own feelings.

Children need to know age appropriate information about what is happening in the world around them and in trauma.  Honestly if we don’t give it to them, they will find out about it from someone else who may or may not have accurate information.  If parents or therapists are able to facilitate an age appropriate discussions, safe adults control the flow of information – not the next door neighbor who heard something from his cousin who heard it from their best friend, or who knows where else!

Also – children will just plan old MAKE UP information if they do not have accurate information – and not necessarily consciously.  One of my favorite Deb Dana quotes is “story follows state”, meaning that we create stories and assign meaning to our dysregulated nervous systems. 

It is also important to not just have one conversation about COVID-19 – this is not a one and done topic.  Find the healthy balance between flooding children (ie bringing it up multiple times per day) and avoidance (no conversation).  Checking in from time to time to see what questions they have or updating on information is essential.

Below are some resources to help explain and process COVID-19 with children:
National Child Traumatic Stress Network Parent/Caregiver Guide To Helping Families Cope With COVID-19

The Story of the Oyster and the Butterfly: The Corona Virus and Me – Free digital book to help children understand COVID-19

Come Inside Bear – a children’s story about social distancing

Our Hero Is YOU – Free digital book to help children understand COVID-19

Assess and Support Family Stress:
As much as I love a good parent check in, I have been taking much care to check in more so with family systems these last weeks and will continue to do so.  I strongly believe that parents are the most important people in their child’s lives, and now more than ever, they are holding the container and structure for their child’s wellbeing. The concept that you need to put on your own oxygen mask before you help others and as mental health professionals is so important, because we need to make sure we are supporting and regulating the family system so the system can regulate the child.  This might mean extending sessions or adding additional sessions in the week to make sure families are getting the support they need.

Validate and Express Feelings:
All feelings are OK!  I love to say that our feelings are our bodies compasses for what is going on in the world around us.  This is also along the lines of Dr. Dan Siegel’s “Name it to tame it” concept! 

There is also so much grief and loss in COVID-19, beyond the physical lives that will be lost.  The play that never was performed, the vacation that was cancelled, the graduation ceremony that was missed, and the grandparents that can’t be squeezed.  Emotions will cycle, things will become repressed and “come out sideways”, and sometimes things will feel stuck. 

As adults it is also so important that we model these feelings for children. That we can own, talk about, and name the feelings as well as show children how to regulate in a way that is helpful. I am having a lot of conversations with families about practicing relaxation and calming techniques together as part of the routine.  This might include deep breaths, family game night, walks, a family gratitude practice, meditation, or dance parties!

Routine And Structure – But Not Rigidity:
I love the saying “trauma is chaos structure is healing” and I have used that quite a bit these last couple weeks. Creating a routine and consistency, and continuing with routines already in place, can significantly benefit our nervous system by letting it know what to expect.  There is definitely comfort in routine. In addition to a schedule that is visual, it might be really helpful and necessary to go over this with children verbally at several points through the day.  Get to the point where children roll their eyes and say “I know, I know” – this is the sweet spot where they know exactly what to expect!

On the other hand, step away from rigidity and have realistic expectations of what might be accomplished in the day, knowing that our nervous systems are all on high alert likely leading to those things I talk about HERE including anxiety, anger, fixations, rumination, etc. We will likely not be at our most productive and running at optimal performance – and that is okay. Children (especially because we may be spending more time in our brainstem where it is really hard to learn anything new) will likely not be taking up basket weaving, mastering a new language, or excelling at gymnastics during this time. Identify the bare minimum, good enough, and go with that. It is also okay if you are 10 minutes late for lunch, need to shorten the hour bike ride to a half hour, or wake up around breakfast-ish not at 6am like planned! Everyone in this time needs a little grace.

Physical Distance NOT Social Distance
Even though we can’t occupy the same physical space as others it is so important as humans to connect with one another.  What were the activities that children were engaging in before COVID-19?  Can we get creative and move some of these online?  I have seen AMAZING things with transitioning to all virtual Play Therapy BUT am also seeing other communities rally as well!  I have seen virtual dance classes, karate, choirs, and occupational therapy! How can we help children connect with others through video chat platforms, community challenges such as this free downloadable Lego Challenge, or a weekly lunch or tea date with grandparents or best friends? 

Move Your Body
This one I cannot emphasize enough.  With all the cortisol and adrenalin building up in our bodies due to the stress response we likely all have to some degree these chemicals need to be burned off by movement.  Now, these chemicals are meant to be burned off by running for our lives or fighting for it BUT dance parties, jumping on the trampoline, yoga, bike rides, and walking the dog will work too!  These ones are also A LOT more fun!
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And as I have been saying a lot lately *with humor of course* – what else do you have to do?
 
What are your favorite ways of COVID-19 Coping for either yourself, your families, or the children you work with?  Drop a comment below! 

One of the biggest topics in my virtual office these past few weeks has been normalizing children’s stress response to COVID-19. Families I work with range from seeing restrictions as an annoyance to full on panic, but nearly all of them realize that this is something new and uncharted for children, our nation, and the world. Even the healthiest and most well-regulated children and families are feeling the impact.

Okay – brace yourself – 99.9% of children in the world today, in this moment, live with some form of pandemic related movement restriction. For many families this comes with an increase difficulty in getting nutritional, education, financial, and safety needs met among others. 

Past research has shown us that during times of health emergencies leading to closing of schools and other social services resources, children are at heightened risk for exploitation, violence, and abuse.  And additionally, those young people who needed the support of a strong special education team to meet their needs are left without crucial services and at high risk for falling behind or further behind.  All of this is an additional to the anxiety, fears, and rumination about the pandemic in general – especially for children who have parents that are essential workers or work in the medical field and need to leave the home or who love and care about someone who would be at high risk for infection.  Let’s face it – that definition encompasses most children.

So here is the other thing –although we know children will be impacted by the pandemic, we can’t assume that all children will have a trauma response.  Although we can agree that COVID-19 and the global impact of this pandemic is traumatic – it depends on children’s perceptions if a trauma response will develop. The child that thinks “Everyone I love will die” will likely have a different reaction than the child that thinks “I know we are doing everything we can to keep safe”.  The child who has had one or more family members pass away from COVID-19 in a community with a high infection rate such as New York is likely to have a different response than a child from a rural community that has had low rates of infection.

Every child will react a slightly different way to COVID-19. The good news is there are no right or wrong ways to feel – all feelings and behaviors are the bodies way trying to make sense, process, and regulate as well as meet our needs. While some choice may be unhelpful – all behavior is purposeful – an attempt to get to a regulated and safe state.  It is through this lens that we can gain an increased understanding of what is driving the behaviors so we can problem solve alternatives.      

To be honest, some children may LOVE the fact that they get more time with their parents and the decrease in transitions from home to school and activities. They might enjoy the fact that they don’t have to go to a school where they get bullied or have significant separation anxiety.  Young people may also like the fact that everyone else can’t go out without them, and they don’t have to see social media pictures of hangouts, movies, or birthday parties they weren’t invited to.  For those with social anxiety, it is a welcome break to engage with others from behind a screen and not having the pressure of being called on in class.

For other children these feelings of positivity and relief will definitely not be the case.  They may be angry, tantrums may increase, or irritability may come out.  Toys may be broken, names called, and art work ripped up.   Children may hyper-focus on the small things in an attempt to gain some form of control.  All of a sudden it becomes really important to have a certain brand of cereal or they HAVE to wear their favorite shirt even thought it is in the laundry. If it doesn’t go their way, it may seem like their anger comes out of nowhere, big and explosive. Also, in an attempt to gain control, there might be a spike in noncompliance of expected tasks.  The simplest thing may turn into an all-out battle. 

Some kids have hyper focus on anxiety triggers and will spin out and ruminate on minor triggers.  One of my favorite Deb Dana quotes is “story follows state” – meaning that our brains will create stories or reasons WHY our nervous system is dysregulated.  Oh – that math assignment you didn’t turn in last year?  The cookie you took from the grocery store at age 7?  When you said something mean about your friend on the playground earlier this year? YES! That is why you are anxious!  And sometimes our brain feels like if we can just solve this problem in front of us everything will be better! 

For me this week it was trying to find a note I had written on an index card leading me to tear apart up and down my home “office”.  Where did I find this note?  Not at all on an index card, but actually on a post-it turned upside down on my desk.  Spoiler alert – finding the note didn’t regulate my nervous system.

Other times anxiety can take over in an attempt to gain control by becoming very focused on routine, structure, or placement. Sometimes children (and adults too) convince themselves that they will regulate if their routine doesn’t change, their books are in the right place, or when nobody switches chairs at the dining room table.  There can be sadness, meltdowns, and tears if things are out of place. 

There can also just be sadness in general. A down mood, feeling slowed down, and concentration can be difficult.  You might give a child instructions 3 to a zillion times and they might not be able to focus enough to finish a task.  Other kids might get jumpy, have a flight energy, and be constantly moving their bodies. 

Kids also might feel flooded or overwhelmed by the range of feelings and just want to check out or disconnect and numb from their body.  This could look like binge watching TV shows, getting sucked into video games, or even the child that is re-reading the whole series or Harry Potter again barely coming out of their room to eat. You might also hear that kids are bored or there is “nothing to do”.  Nothing brings joy or excitement.

Also, because most of our nervous systems are on high alert and likely pumping out large amounts of cortisol and adrenaline children can get tired, lethargic, and oversleep.  A lot of young people are pushing bed times to later at night and sleeping in later in the day.  Other kids may put all of their effort and energy into SOMETHING like organizing their rooms or planning their fairy garden for the summer.

Other young people may have regressive behaviors.  This is when emotional or physical responses regress or "go backwards" to an earlier age.  This might mean talking in a way that is younger than their age, clinging to safety objects like a blanket, sucking thumbs again, waking up in the middle of the night, having bathroom accidents, or being unable to sleep on their own. 

Whatever the response, and let's be honest - the range is wide,  the hope is we can have compassion for all the ways we are trying to make sense of these times.  Hope that we can meet children where they are at and help create a felt sense of safety and co-regulation.

I SO want to keep the ball rolling on this conversation - leave a comment about what other responses have you seen within yourself, your family, or the children you work with!