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Child & Adolescent Psychotherapy > Exam 2: Homeyer and Landreth > Flashcards

Exam 2: Homeyer and Landreth Flashcards

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1
Q

Sandtray is a tool for self expression & self exploration

A

Sandtray:
• Childs internal world is expressed through the sand tray
• Easier to express trauma nonverbal thoughts/feeling
• Allows for emergence of metaphor
• Adults speak metaphors - child “plays metaphor”
• Adults & children use
• Miniatures “objects”
○ Nature, animals, humans, shadow items (dark/ugly), transportation, buildings, structures
*important - level of organization / order

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2
Q

3 steps in Sandtray/Play Therapy

A

Step 1: Set up the room
Step 2: introduce sandtray (directive + non-directive)
○ Put any items they wish into tray
○ *Non-directive = put as many miniatures wherever youd like
○ Directive - on one sand build world before divorce & the other side - after

Step 3: client creates the scene
Provide holding environment with calming presence = Child needs to feel Emotionally safe

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3
Q

Role of the therapist

A

○ Attuned witness , non-judgement, Empathic, freedom & protection that encourages them to express inner selves in safe non-judgemental place
○ follow the child’s lead (vs imposing structure or guidance on play)
○ Photograph session (put into notes)
○ Clean up
○ Don’t check out - stay present
○ Don’t engage in conversation
The process is the therapy (no analysis of symbols needed for meaningful therapy)

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4
Q

2 most important things?

A

DON’T TOUCH - unless invited by client

DON’T INTERPRET

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5
Q

6 steps during Sandtray process:

A

Step 1: visually observe completed santray

Step 2: Emotionally observe sand tray

Step 3: Evaluate the organization of the tray
Types of organization:

Step 4: identify the metaphor
○ The story line (the manifest content) process in story line - respectful of defenses
○ The meaning (latent content)

Step 5: Document the session
(Take picture of completed sandtray + include in client file)

Step 6: clean up

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6
Q

Step 3: Evaluate the organization of the tray

Types of organization:

A

An empty world (2/3 or more is empty) reflects view of world as unhappy, lonely, rejection, need to escape

Unpeopled world = wish to escape or hostility toward ppl (soldiers-typically represent aggression/protection)

Close or fenced world = client uses fences or dividers
(closed-most items inside fences)
□ May reflect need for protection, compartmentalize, fear of own impulses

Rigid world  (aka "skematic") : patterns or rows
				□ arrange of miniatures is unrealistic 
				□ reflect need for order, control or perfectionism, emotional rigidy (mandala - not rigid)

Disorganized world incoherent/chatoc - chaotic impulsive items - reflect inner confusion or inability to control self

Aggressive world - war, animal attack, angels/babies aggressive -
□ reflect anger or internal violence

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7
Q

2 ways of processing Sandtray:

A
  1. Global Processing (what you would say) sit from clients perspective when looking at ray
    ○ Title = “what is the title of your tray” or “whats the name of your world”
    ○ General (global) explanation
    Tell me about your story
    Free narrative
    When they’re done - provide summary back to them

○ Discuss each scene
○ Discuss each miniature
Ask about significant ones w/facilitative responses & questions

  1. Focused processing (less organized/more chaotic worlds)
    ○ Title
    ○ General explanation
    ○ Discuss each miniature
    ○ Give voice
    ( Ask them to speak for the miniature & facilitate dialogue between them )Help them process different parts of self

○ Understand intuitive meaning (not doing for sand tray)
Carl Jung “archetype”
○ Notice interactions
○ Proceed with action

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8
Q

Trays often follow erikson developmental themes

A

TRUE

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9
Q

What does child do?

A

May or not play or engage

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10
Q

Termination:

A

Termination: Non-verbal work = don’t know when to end (p.54 & 55)–>themes for term

  • Less chaos or rigidity in the tray
  • More order & balance
  • When miniatures are deliberately selected and carefully place
  • Clients see themselves in the tray

Not when they don’t have problems - looking for resolution in stories to problems

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11
Q

Sandtray

A

expressive & projective psychotherapy
involves: unfolding & processing of intra/interpersonal issues
through sandtray: as nonverbal medium of communication

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12
Q

why use sandtray

A

expression to nonverbalized issues

sensory experience

creates therapeutic distance - allows client to direct process

inclusive experience

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13
Q

what is the primary responsibily of the therapist in sandtray?

A

provide a “holding environment” or “free and protected space” for child to feel emotionally safe

	○ Attuned witness , non-judgement, Empathic, freedom & protection that encourages them to express inner selves in safe non-judgemental place 
	○ follow the child's lead  (vs imposing structure or guidance on play) 
	○ Photograph session (put into notes) 
	○ Clean up 
	○ Don’t check out  - stay present 
	○ Don’t engage in conversation 
	○ The process is the therapy (no analysis of symbols needed for meaningful therapy)

be fully present
silently but emotionally enter sandtray with child
observe process

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14
Q

while chid is creating sandtray = therapist is silent

A

TRUE

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15
Q

important to have miniatures that are disproportionately large

A

victimized clients use large predatory creatures = metaphor for emotionally/phsyically overwhelming experiences of being victimized

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16
Q

When we get really focused on trying to understand everything the child is doing we lose the child

A

A therapist who is too literal minded and who cant tolerate a childs flight into fantasy without ordering to it into adult meaningfulness might well lost at times _ virginia axline

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17
Q

Play can reveal:

A 
Play can reveal: 
	- What happened
	- Reactions
	- Feelings
	- What the child wishes, wants or needs
The child's perception of self
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18
Q

Play:
Function: to act out situations (language)

Symbolic play: gives expression to child’s inner world (learn how to cope with big feelings)(toys=words)

A

TRUE

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19
Q

Play therapy is:

dynamic interpersonal relationship btwn a child and therapist: who provides materials/faciliates dev of safe relationship for the child to: express & explore feelings through play-the childs natural medium of communication, for optimal growth & development

A

voluntary
intrinsically motivated
child-directed activity involving flexibility of choice
no intrinsic goal exists

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20
Q

the success or failure of therapy rests on the dev & maintenance of the therapeutic relationship

A

toys are like worlds by children and play is their language

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21
Q

stages of feeling in the play therapy process

A
  1. diffuse negative feelings
  2. ambivalent feelings (anxious/hostile)
    “I dont like any of the toys”
  3. direct negative feelings toward family (forms of regression)
    “I’m going to shoot them”
  4. ambivalent feelings both pos & neg towards family
    “kills toy, then later helps toy”
  5. clear, distinct, separate & realistic positive attitude
    (resolution of current problems)
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22
Q

Child centered play therapy is based on a belief in the capacity and resiliency of children to be constructively self directing

A

Creating conditions of worth and growth –> child naturally grows from it

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23
Q

Play therapy:

objective of the therapist

A

Objective of therapist:

Relate to child inw ays that will release childs inner directional, constructive, forward-moving, creative, self-healing power

*Not about teaching or cognitive changes -

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24
Q

when you focus on the problem you lose sight of the child

A

TRUE

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25
8 basic principles for child therapy
1. Genuine interest in child (warm, caring relationship) 2. Accepts child 3. Child fees safe to express/explore 4. Sensitive to & reflects feelings 5. Childs capacity to be responsible / solve problems 6. Trusts childs direction/lead - (no directing) 7. Gradual process (no rush) Establishes limits that help child to accept relationship responsibility
26
Play therapy has No treatment plan
TRUE inability to be present with child
27
the relationship is the therapy/KEY TO GROWTH ; it is not preparation for therapy or behavioral change
TRUE
28
10 objectives of play therapy
``` 10 objectives of play therapy Focus on person rather than problem 1. Positive self-concept 2. Self responsibility 3. Self-directing 4. Self-accepting 5. Self-reliant 6. Self-determined decision making 7. Control 8. Coping 9. Internal evaluation Self-trusting ```
29
how therapist feels about child is more important than what therapist knows about the child
TRUE
30
child will not change until the child is free not to change
TRUE
31
4 healing messages that therapist works hard to communicate at all times
1. i am here 2. i hear you 3. i understand 4. i care
32
therapist tone of voice & expression is congruent with
childs affect & therapists responses
33
responses should be short, 10 words or less
true: brief & interactive
34
Play therapy Skills: Reflect nonverbal play behavior "tracking"
therapist states observations of what child is doing DO NOT IDENTIFY THE ITEM UNTIL THE CHILD DOES
35
These are examples of what play therapy skill: "you are pushing that right over there" "you are kicking that" "you are jumping on top of that"
TRACKING: reflect nonverbal play behavior - validates child state what their doing without naming objects until child does
36
meaning of: child says "why are you looking at me"
therapist not verbally active enough
37
tracking responses shows therapist interest in understanding their world, communicates involvement & participation
promotes security and warmth and genuine interest in what child is doing
38
What are the Play therapy skills
``` tone of voice frequency tracking (nonverbal bhvr) reflect content reflect feelings decision making/responsibility praise (vs encouragement) esteem building statements settings limits ```
39
Play therapy skill: therapist repeats in slightly diff words something child says
REFLECTION OF CONTENT: therapist repeats in slightly diff words something child says * DO NOT PARROT CHILD * STAY w/ METAPHOR CHILD USES
40
This is an example of what play therapy skill: child puts dishes on floor: "its time for dinner everycome come this minute" therapist responds: "you're letting everyone know that dinner is ready"
REFLECTION OF CONTENT: therapist repeats in slightly diff words something child says * DO NOT PARROT CHILD * STAY w/ METAPHOR CHILD USES
41
reflection of content: allows child to feel heard validates their perception of experiences helps clarify their understanding of themselves
TRUE
42
Foundation of all play therapy =
tone of voice Younger the child & more disregulated = more reliance on tone of voice (VS words) Tone = matches affect/intensity (ex. Sad = low/slow; mad = firm)
43
play therapy skill: reflecting feelings
communicates understanding / acceptance of childs feelings & needs helps child self-understanding & identify/express feelings *communicate empathy
44
this is an example of what play therapy skill: child: "would you just go get the paints: therapist: "you're angry at me because i won't get the paints for you but thats something you can do if you want the paints
reflecting feelings ``` "some of the things I do bother you sometimes" "you look confused" "sometimes you feel all alone" "right now you feel sad" you're angry that it doesn't fit" ```
45
play therapy skill: self-esteem buidling comments
childrens behaviors reflects how they feel about themselves - therapist responds with self-esteem building comments helps child recognize competency & their strengths
46
this is an example of what play therapy skill: you figure out how to put all those pieces together you got that toy all by yourself you decided what you would like to do
ESTEEM BUILDING STATEMENTS you have something in mind looks like you know how to... you remembered where that was you decided... you know just how you want it to look
47
therapist tone of voice & degree of affect match the level of affect/intensity expressed by the child
expressing affect beyond what the child has expressed = child expresses affect/behaviors beyond what they are genuinely feeling
48
NEVER ASK QUESTIONS
true: asking questions implies lack of understanding & takes child our of the world of emotion into cognition & place focus of relationship on therapist
49
play therapy skill: | facilitate decision making and return responsibility to child
when child asks question or seek assistant = return responsibility to child to make own decision "in here, its up to you to decide what youd like to do" "that can be whatever you want it to be" When you do for the child what she can do for herself, you teach the child that she is weak
50
what play therapy skill? child: "will you do ____ for me?" therapist: "in here thats something you can do"
facilitate decision making & return responsibility to child child: "what pictures do other kids draw?" therapist: "in here, the important thing is the kind of picture YOU like to draw" child: "what do you want me to play with first?" therapist: "sometimes its hard to decide. what you play with first isf or you to decide"
51
respond to child with "you" instead of their first name ex. "you really like hitting that" instead of --> "david really likes hitting that"
denies the presence of the child and causes them to feel talked about as a nonperson
52
DO NOT LABEL TOYS
this anchors teh child to the therapists reality & intereferes with childs creativity/fantasy
53
play therapy: no place for any form of evaluation
TRUE | children dont feel say when evaluated
54
DO NOT PRAISE child - only encouragement
Ex. "do you like my picture" "oh its beautiful" = praise statement based on external evaluation leads child to become dependent on external reinforcement & external motivation
55
Setting Limits (ACTS)
Acknowledge the feeling: (I know youre really angry right now) Communicate the limit: (The blocks are not for throwing, I am not for hitting) (reduces blame/shame ) Target Alternative: (If youd like to throw something you can throw this sponge at the wall - give them something else to do (1 or 2 options) State final choice: (if you choose to throw the block then youre choosing not to play with the blocks today) (use only if child really tests limits)
56
the establishment of total limits rather than conditional limits is more effective
TRUE - total limits are less confusing
57
limits are not needed until they are needed
TRUE: the objective is not to stop the behavior, but to faciliate the expression of the motivating feeling, want or need in a more acceptable manner
58
process of setting limits about leaving playroom
"our time is not up in the playroom. you just dont like anything here and want to leave, but our time is not up. We have 15 more minutes and then it will be time to leave"
59
when child is silent
allow child not to talk - acceptance is not conditional responsive attitude doesnt depend on child talking
60
when child wants to bring toys/food into playroom
favorite is allowed for first session ``` no food no toys (no: books/games) ``` rule: allow only those items that would normally be selected for the playroom in response to childs desire to bring toy "i know you would like to take that game with you to the playroom, but it is for staying here in the waiting room. It will be here when you come back from the playroom"
61
when child is overly dependent
return responsibility to child & faciliate their self-reliance child must be allowed to struggle with making decision & doing things for themselves go get those for me = "you would liek to have the scissors. If you awnt scissors you can get them" will you stack those blocks for me? "thats something you can do"
62
when child persits for praise
therapist: "what is important is what you think/feel about your picture"
63
child says you talk weird
"oh so i sound different than other people to you" or offer an explanation: "im just trying to let you know im interested in you and what you are doing. i guess maybe what i say does sound different" or if its said negatively: "you dont like the way i talk" or "sounds like you might want me to stop talking"
64
when child wants therapist to play a guessing game
child: "guess what im going to do" therapist: "you have something in mind" child: "what do you think this is?" therapist: "you can tell me"
65
when child asks for expression of affection
child: "do you like/love me" therapist: "you are special to me and this is a special time together" DO NOT REFLECT "you're wondering if i like you"
66
when child steals a toy
dont ask questions you already know the answer. make straightfoward statements WRONG: "did you forget something/did you take the car?" RIGHT: "i know you would like to take the care with you but the car in your pocket stays here so it will be here for you to play with next time" if child denies it: "you would like to pretend you dont know where the car is, but the care in that pocket (point) stays in the playroom
67
when child refuses to leave
"our time in the playroom is up for today. its time to go tothe waiting room where your mother is" (slowly move towards door & open it) "you would like to stay longer to play in the sand, but jessica, time is up for today"
68
when therapist unexpectedly cant make an appt
inform child in prior session and affirm you will see them the following week you can give general explanation "im going to be in another town at a meeting" leave voicemail to child
69
Play therapy stage 1 (session 1-4)
``` curious explore noncommittal/creative play happiness + anxiety simple descriptive comments ```
70
Play therapy stage 2 (session 5-8)
aggressive play | spontaneous reactions
71
Play therapy stage 3 (session 9-12)
creative play + happiness nonverbal checking w/therapist self-disclosure
72
Play therapy stage 4 (session 13-16)
creative + relationship play aggressive play happiness - bewilderment - disgust- disbelief
73
play therapy stage 5 (session 17-20)
dramatic + role play relationship building w/therapist happiness
74
play therapy stage 6 (21-24)
relationship play dramatic play role play incidental play increase
75
adjusted vs maladjusted: wants to be directed
maladjusted:
76
adjusted vs maladjusted: uses a lot of toys spontaneous reactions
adjusted
77
adjusted vs maladjusted: cautious & deliberate
maladjusted:
78
adjusted vs maladjusted: expresses feelings symbolically
maladjusted: | clay, sand, water
79
adjusted vs maladjusted: aggression without destruction responsibility for expression
adjusted
80
adjusted vs maladjusted: in first session: non-acceptance of play & inense dramatic role play
maladjusted

Child & Adolescent Psychotherapy (3 decks)

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