334 | Preparing Parents for What's Coming: Set Expectations Early or Struggle Later

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You're listening to the Play Therapy Podcast with Dr. Brenna Hicks,

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your source for centered and focused play therapy coaching.

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Hi,

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I'm Dr. Brenna Hicks,

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The Kid Counselor.

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This is the Play Therapy Podcast where you get

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a master class in child-centered play therapy

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and practical support and application for your

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work with children and their families.

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In today's episode,

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I am answering a question from McKenzie in Illinois.

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Actually two questions.

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They're sort of related,

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and

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she's writing in about

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when parents and or kids

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are asking for less frequent sessions rather than weekly.

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And then also

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when we're later in the process

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and there's resistance or avoidance,

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how do we navigate that because obviously if we're past resistance phase

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and we still see the refusal to come back or avoiding of work or regression,

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anything like that,

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what is best practice for dealing with that?

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So very helpful questions.

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I'm going to read parts of her email and then we'll dive in together.

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I have some questions related to navigating parent

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interactions related to scheduling and distress tolerance.

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In my experience,

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it's not uncommon for clients to want every other week therapy.

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I always recommend weekly for the sake of consistency and speed of progress.

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While I don't rush the healing,

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there is a reality that 4 hours a month versus 2 hours a month can make a difference.

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There's also instances of therapy not being consistent

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in timing or frequency due to various factors,

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which also puts me in a dilemma.

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I don't know how much progress is able

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to be made with sporadic inconsistent scheduling.

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I think this also ties into what I've noticed as an overall trend.

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Parents' distress tolerance in seeing their child in distress and discomfort

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with the therapeutic process,

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which leads to all-round avoidance.

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Conversations with my families about scheduling and distress

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tolerance with therapy is a recurring theme,

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and I'm wondering how you go about it.

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I find myself in a conflict of values.

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I want to meet clients where they are,

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which is sometimes in a season of inconsistency or low tolerance,

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but I professionally believe that a consistent weekly

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therapy schedule is best for long term outcomes,

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and challenging one's own discomfort in therapy is where growth really happens.

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All right,

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so we'll pause there.

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There's another question coming,

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but

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let's stop there.

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Yes,

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100% the more consistent therapy is,

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and weekly is the ideal schedule.

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We know that they have proven CCPT works on different schedules

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and we know that it does not have to be 50 minutes every week for it to work,

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but the standard ideal is going to be 50 minute sessions once weekly.

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Why?

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Because it allows us to build momentum.

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It's spread out enough that the child doesn't get overwhelmed,

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but it is not too far out that we kind

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of lose the the progress and the growth potential.

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So,

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yes,

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very much so

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when we

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meet with parents for the first time.

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One of the things that we do

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is to communicate very clearly

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that the expectations are same time,

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same day each week.

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We essentially communicate to them that we reserve that spot for that family.

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In other words,

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we have the initial parent consult,

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we sit down

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and we say,

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OK,

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we have Tuesdays at 4 o'clock opening up,

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and that will be your time slot.

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We will not book anyone else in that position

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and you will have that Tuesday at 4

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for the duration of therapy.

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OK,

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what the implication there is

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is that

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you need to be here every week because this is your spot,

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and we don't really give an option of biweekly therapy.

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If someone asks due to

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schedule,

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due to

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time sharing custody issues,

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due to financial considerations,

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whatever so sometimes you will get people even when you make that clear,

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you're going to have Tuesdays at 4 every week reserved for you

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if they bring up that they would like to do biweekly.

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You have to make it clear that that is not therapeutically advised.

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And you have to give them some reasons and you've already addressed those,

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so I suspect McKenzie,

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that you know what those are and you need to make that clear.

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So much of the hindrances and the barriers and the obstacles

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in working with children in CCPT,

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it comes back to what expectations are communicated in the very first meeting.

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We do not have parents that

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don't show up.

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We don't have parents that ask to come less frequently we don't have parents

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that back out of therapy when times get rough

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because we've spent so much time investing in the expectations

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in communication

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and in articulation about what's going to happen,

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how we're going to handle it,

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what needs to happen,

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what will not happen

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when you set the groundwork from the very first meeting.

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You're falling back on information that's already been communicated

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rather than trying to communicate it down the road

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when they're dangling.

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When you're in damage control mode,

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it's way harder

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to keep a parent coming

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and keep a child coming

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than if you said from the very beginning

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there's going to be a point in time where

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you might think that you could reduce frequency of sessions.

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And unless we're moving into the termination phase,

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we're going to need to continue with weekly sessions.

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That's how we preserve momentum.

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That's how we ensure that

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the highest amount of growth is being achieved.

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That's how we can ensure that the child is able to

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stay in the therapeutic groove once they're in work phase.

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If you communicate valid reasons,

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you're not making them up,

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they're empirically supported reasons.

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When you communicate the why

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behind needing weekly sessions,

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parents will agree,

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but it has to be communicated so readily and clearly from the beginning,

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and then you fall back on it.

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And so yes we meet clients where they are of course

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and yes we validate their concerns and we validate that there are some issues

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but when it all comes down to it,

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what we say is

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not to

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parents specifically I'm just saying in general like

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at our center we use the phrase a lot

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people will prioritize what's important to them.

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So therefore we have to make sure that parents are going to prioritize therapy

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and we have that conversation

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we say

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this is a commitment this is a time investment,

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this is a financial investment

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we're going to be together for potentially 30 to 40 weeks

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we're going to see each other every week for

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5, 6, 7 months.

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This is something that you need to be prepared for.

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This is something that you need to commit to.

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And we need to all work together

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to get the outcomes that we want.

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And

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if

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violin lessons or

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sports or homework or

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time sharing or.

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distress

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tolerance,

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whatever,

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whatever the scenario is,

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if that's getting in the way.

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We come back to the parent and we say,

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You committed when we first started that this was going to be a priority,

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and we have already come so far,

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we've already worked so hard,

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we already have so much momentum built.

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If we were to reduce frequency now,

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it would become a barrier.

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We need to keep this going,

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but that had to have already been established.

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So I really can't stress enough the importance of that first meeting,

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being setting the stage and the tone for everything that follows.

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So,

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I hope that that's helpful in that question.

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And then,

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let's get into the second question.

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I understand separation anxiety and resistance when

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a child is earlier in the process,

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but what about if you are much later in the work phase?

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I have a client with anxiety who has been in the work phase for a while.

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We have a solid rapport and my intuition tells me that we're nearing

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the root of their issues and really uncovering and processing through something.

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They've gone from engaged,

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laughing,

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playful,

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power and control,

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and excited

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to a more withdrawn,

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guarded,

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anxious power control.

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There have been more difficulties with the child wanting to come into the playroom,

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refusing to play,

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seeming like they hate me and sessions.

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Overall,

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lots of power and control struggles.

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They often want me to lead the way then be a baby.

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When entering and then leaving the room,

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but flip completely went in session.

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I don't take it personally because I know it's the

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process and it has nothing to do with me,

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but I'm feeling stuck.

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I can tell we're getting into some really vulnerable territory,

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and it appears there is a lot of fear facing with it

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and thus re resistance or regression.

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But I also noticed progress,

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and parents have reported that while there is more anxiety,

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there is still progress outside the home as well,

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which is puzzling.

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Maybe this is the pendulum swing and the child is trying to find center.

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I'm not sure.

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I'm trying to tie together all your concepts.

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I'm curious to know what this sounds like to you and recommendations

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to be mindful of or stories you have of similar past experiences.

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Should I allow for caregivers to be in sessions if

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it looks like separation anxiety and or shortened sessions?

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Since we have a rapport and haven't had issues before,

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I'm not sure if I should go backwards or if that

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would be appropriate short term when they're struggling to come back.

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I'm trying to have confidence that my client will work it out,

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but they're struggling and internally,

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so am I.

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All right,

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so

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McKenzie,

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let's talk about this now.

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Related a little bit to earlier,

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but again,

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this is about making it known from the beginning.

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You have to prepare parents for resistance.

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You have to prepare them for when a child refuses to come back.

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You have to prepare them for when a child says they

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hate you and they never want to see you again.

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You have to prepare them for them saying,

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fine,

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if you take me,

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I'm not gonna play.

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I'm just gonna sit in the corner and stare at the wall.

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All of the things that are

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nothing new under the sun in a CCPT playroom,

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you have to prepare parents that those are potentials.

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You have to prepare parents for what might come.

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And so again,

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first initial visit,

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you have to talk about what

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could happen.

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And then when it does,

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they're not caught off guard,

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they're not shocked,

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they're not overwhelmed,

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they're like,

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oh right,

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she said this was going to happen.

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All right,

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so that's a big piece of it

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and 100% what you're describing

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is resistance to the work phase.

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So

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I've said this a lot in coaching.

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00:10:12,140 --> 00:10:14,609
I don't know that I've talked about it a whole lot on the podcast,

271
00:10:14,659 --> 00:10:16,010
so I'm glad we can dive into this.

272
00:10:17,179 --> 00:10:20,229
I wanna make it real clear that we have phases,

273
00:10:20,479 --> 00:10:20,719
right?

274
00:10:20,840 --> 00:10:22,359
So we share this with parents,

275
00:10:22,440 --> 00:10:24,159
we help them understand there's initiation,

276
00:10:24,280 --> 00:10:25,070
then there's resistance,

277
00:10:25,119 --> 00:10:25,609
then there's work,

278
00:10:25,679 --> 00:10:26,570
then there's termination.

279
00:10:26,960 --> 00:10:30,250
That is something they need to know from the very first meeting they have with us.

280
00:10:30,349 --> 00:10:31,479
This is what you can expect.

281
00:10:31,520 --> 00:10:32,869
This is how this goes.

282
00:10:33,320 --> 00:10:35,719
The initiation phase involves this resistance phase

283
00:10:35,719 --> 00:10:37,469
involves this work phase involves this.

284
00:10:38,200 --> 00:10:39,590
We're painting the whole picture for them.

285
00:10:39,760 --> 00:10:40,640
That's really important.

286
00:10:41,380 --> 00:10:45,179
But it is also very important to know that it's not always 1, 2, 3, 4.

287
00:10:45,429 --> 00:10:47,390
Kids do not always start with initiation

288
00:10:47,830 --> 00:10:49,900
and then necessarily move into resistance.

289
00:10:50,150 --> 00:10:51,580
Sometimes they dive straight into work.

290
00:10:51,789 --> 00:10:55,010
They go straight to phase 3 and they bypass 1 and 2,

291
00:10:55,150 --> 00:10:56,859
but it's like the stages of grief.

292
00:10:57,190 --> 00:10:59,340
You cannot bypass a stage,

293
00:10:59,510 --> 00:11:00,630
you have to go through it.

294
00:11:01,320 --> 00:11:03,640
So eventually if they go to 3 first,

295
00:11:03,809 --> 00:11:05,409
they come back to 1 and 2,

296
00:11:05,650 --> 00:11:07,239
not necessarily in that order,

297
00:11:07,450 --> 00:11:10,010
but they inevitably go through all 4 phases.

298
00:11:10,090 --> 00:11:13,239
It just doesn't always necessarily go in that stair step.

299
00:11:13,929 --> 00:11:14,940
Likewise,

300
00:11:15,330 --> 00:11:18,119
there is resistance in each phase.

301
00:11:19,340 --> 00:11:22,030
So sometimes there is resistance to initiation.

302
00:11:23,140 --> 00:11:26,090
They have resistance to building a relationship with you.

303
00:11:26,380 --> 00:11:28,710
They have resistance to trusting you.

304
00:11:28,900 --> 00:11:31,809
They have resistance to letting their guard down

305
00:11:32,140 --> 00:11:34,419
and feeling like you're an ally in the playroom.

306
00:11:35,020 --> 00:11:38,150
That is resistance in the initiation phase.

307
00:11:38,580 --> 00:11:40,770
Then they hit resistance phase,

308
00:11:40,780 --> 00:11:43,130
which obviously there's resistance and resistance,

309
00:11:43,140 --> 00:11:43,590
yes,

310
00:11:43,820 --> 00:11:45,450
but then they hit work phase

311
00:11:45,780 --> 00:11:48,840
and then sometimes they resist the work that they need to do.

312
00:11:49,739 --> 00:11:50,659
This is hard.

313
00:11:50,799 --> 00:11:51,929
I've done some work,

314
00:11:52,059 --> 00:11:52,440
but man,

315
00:11:52,500 --> 00:11:53,739
this other stuff coming up,

316
00:11:53,820 --> 00:11:54,820
this is awful.

317
00:11:54,900 --> 00:11:56,369
Like I just don't wanna do this.

318
00:11:56,659 --> 00:11:59,049
So they hit resistance within their work.

319
00:12:00,039 --> 00:12:02,559
Then sometimes there's resistance in termination.

320
00:12:03,289 --> 00:12:04,940
I don't think I can do this without you.

321
00:12:05,070 --> 00:12:07,520
I don't want to lose this relationship that I have.

322
00:12:07,630 --> 00:12:08,799
I don't want to stop coming.

323
00:12:08,950 --> 00:12:12,859
I'm scared that I'm going to backpedal and be right back where I started again.

324
00:12:13,070 --> 00:12:13,869
So no thank you.

325
00:12:13,950 --> 00:12:17,500
I'm going to show you how upset I am about the idea of wrapping up.

326
00:12:18,960 --> 00:12:21,179
So we have resistance as a phase,

327
00:12:21,380 --> 00:12:24,179
but we have resistance within the phases.

328
00:12:25,330 --> 00:12:31,150
And it's not uncommon for us to be in work and then have an uptick in resistance,

329
00:12:31,320 --> 00:12:34,039
which obviously sometimes it is regression,

330
00:12:34,440 --> 00:12:35,830
sometimes it's avoidance,

331
00:12:36,239 --> 00:12:37,270
sometimes it's resistance,

332
00:12:37,280 --> 00:12:39,429
but we are seeing them push back

333
00:12:40,119 --> 00:12:41,549
from the work that they need to do.

334
00:12:42,400 --> 00:12:43,479
They know what's coming,

335
00:12:43,559 --> 00:12:45,219
they know what they have to tackle,

336
00:12:45,280 --> 00:12:46,229
and it's scary.

337
00:12:46,679 --> 00:12:48,080
So a lot of times they're like,

338
00:12:48,130 --> 00:12:48,219
yeah,

339
00:12:48,330 --> 00:12:48,719
no thanks,

340
00:12:48,760 --> 00:12:50,549
let's tap the brakes and do something else.

341
00:12:50,840 --> 00:12:51,760
This is very common.

342
00:12:51,880 --> 00:12:52,080
Again,

343
00:12:52,159 --> 00:12:53,630
you prepare parents for this,

344
00:12:54,080 --> 00:12:55,109
and at the very least,

345
00:12:55,169 --> 00:12:57,280
you reassure and normalize what's happening.

346
00:12:58,289 --> 00:13:01,119
So that seems very much like what you're describing

347
00:13:01,330 --> 00:13:01,840
and

348
00:13:02,429 --> 00:13:05,239
It's just a natural process in work.

349
00:13:05,450 --> 00:13:05,609
We,

350
00:13:05,650 --> 00:13:06,809
we just have to get through it.

351
00:13:08,010 --> 00:13:10,650
Then when you said it seems like they're getting into

352
00:13:10,650 --> 00:13:13,479
really vulnerable territory and there's a lot of fear facing,

353
00:13:13,690 --> 00:13:17,210
keep in mind anxious kids go through the process slower.

354
00:13:18,530 --> 00:13:20,369
They go through the phases slower,

355
00:13:20,450 --> 00:13:22,039
they go through their work slower,

356
00:13:22,250 --> 00:13:23,719
they warm up slower,

357
00:13:23,969 --> 00:13:24,440
they

358
00:13:24,570 --> 00:13:26,000
hit resistance harder.

359
00:13:26,729 --> 00:13:29,239
That's very consistent with highly anxious children.

360
00:13:29,369 --> 00:13:31,080
So that's another factor to consider.

361
00:13:31,750 --> 00:13:35,960
And the fact that you are noticing progress and parents are noticing progress,

362
00:13:36,250 --> 00:13:39,320
that's because this child has been in work for quite a while.

363
00:13:40,049 --> 00:13:41,030
And yes,

364
00:13:41,239 --> 00:13:41,979
this child is like,

365
00:13:42,039 --> 00:13:42,159
yeah,

366
00:13:42,280 --> 00:13:42,799
no thanks,

367
00:13:42,880 --> 00:13:43,320
I.

368
00:13:44,010 --> 00:13:46,049
I really do not want to do this right now.

369
00:13:46,320 --> 00:13:48,000
This is a lot for me to take in.

370
00:13:48,119 --> 00:13:50,609
I'd rather just avoid and and say

371
00:13:50,880 --> 00:13:52,229
let's do something else instead,

372
00:13:53,039 --> 00:13:53,349
but

373
00:13:53,520 --> 00:13:55,109
it's reverse Pandora's box.

374
00:13:55,280 --> 00:13:57,359
You can't undo the work that's been done.

375
00:13:57,400 --> 00:13:59,000
You can't unlearn what you've learned.

376
00:13:59,039 --> 00:14:00,590
You can't unknow what you know.

377
00:14:01,409 --> 00:14:01,580
So,

378
00:14:01,590 --> 00:14:01,989
of course,

379
00:14:02,030 --> 00:14:06,380
there's going to be progress even in the midst of difficulty of work.

380
00:14:07,159 --> 00:14:08,979
So they go in tandem.

381
00:14:09,400 --> 00:14:11,390
They're kind of on the track at the same time.

382
00:14:11,640 --> 00:14:13,590
So we're absolutely making progress

383
00:14:13,700 --> 00:14:15,150
and things are improving,

384
00:14:15,599 --> 00:14:17,190
but it's very hard.

385
00:14:17,200 --> 00:14:19,320
So there's resistance in the midst of all of that.

386
00:14:20,429 --> 00:14:22,559
And to answer your final two questions,

387
00:14:22,640 --> 00:14:24,719
should I allow for caregivers to be in sessions?

388
00:14:25,479 --> 00:14:26,840
100% no.

389
00:14:27,200 --> 00:14:28,320
That was a very simple one.

390
00:14:29,000 --> 00:14:30,359
And should I shorten sessions?

391
00:14:30,390 --> 00:14:31,469
100% no.

392
00:14:31,630 --> 00:14:31,799
Again,

393
00:14:31,919 --> 00:14:32,799
very simple.

394
00:14:33,159 --> 00:14:36,469
Let's keep in mind there's purpose and intention

395
00:14:36,679 --> 00:14:37,809
in the process.

396
00:14:38,890 --> 00:14:39,520
So

397
00:14:39,770 --> 00:14:41,840
sessions are 50 minutes,

398
00:14:42,130 --> 00:14:44,299
and they are for being in the playroom the whole time.

399
00:14:45,200 --> 00:14:46,400
So we don't shorten sessions,

400
00:14:46,489 --> 00:14:47,919
kids can't earn sessions.

401
00:14:47,960 --> 00:14:49,320
They can't lose sessions.

402
00:14:50,380 --> 00:14:51,179
So therefore,

403
00:14:51,280 --> 00:14:52,890
we're never going to stop early.

404
00:14:53,099 --> 00:14:54,609
It's a 50 minute play session.

405
00:14:55,030 --> 00:14:58,109
So a 50 minute session is for in the playroom for 50 minutes.

406
00:14:59,270 --> 00:15:01,070
We do not ever let parents come back.

407
00:15:01,200 --> 00:15:01,520
Why?

408
00:15:01,820 --> 00:15:02,239
Because

409
00:15:02,479 --> 00:15:05,429
the therapeutic relationship is between you and the child.

410
00:15:06,080 --> 00:15:08,630
As soon as you introduce a third party,

411
00:15:08,900 --> 00:15:10,229
it changes the dynamic.

412
00:15:10,400 --> 00:15:12,070
As soon as you introduce a parent,

413
00:15:12,239 --> 00:15:14,239
it's no longer unconditionally accepting.

414
00:15:14,679 --> 00:15:16,020
As soon as you introduce a parent,

415
00:15:16,039 --> 00:15:17,710
confidentiality is breached.

416
00:15:17,880 --> 00:15:19,429
As soon as you introduce a parent,

417
00:15:19,640 --> 00:15:23,150
they're not able to be adherent to the model because they don't know the model.

418
00:15:23,400 --> 00:15:25,309
And so now there's going to be

419
00:15:25,559 --> 00:15:27,469
all kinds of other stuff happening

420
00:15:27,679 --> 00:15:30,109
that is undermining the CCPT

421
00:15:30,520 --> 00:15:32,109
theoretical approach

422
00:15:32,559 --> 00:15:32,960
et al.

423
00:15:33,049 --> 00:15:35,349
There's so many other reasons why we don't have parents in the room.

424
00:15:36,250 --> 00:15:38,409
So no matter what is going on.

425
00:15:39,369 --> 00:15:41,570
We are going to be adherent to the model.

426
00:15:41,979 --> 00:15:43,330
Sessions are 50 minutes.

427
00:15:43,489 --> 00:15:44,650
It is just for us,

428
00:15:44,859 --> 00:15:46,619
and that's always our why.

429
00:15:47,760 --> 00:15:48,150
Oh,

430
00:15:48,159 --> 00:15:49,630
you'd really like mom to come back,

431
00:15:49,710 --> 00:15:51,909
but you know that our playtime are just for you and me.

432
00:15:53,099 --> 00:15:53,419
Oh,

433
00:15:53,429 --> 00:15:54,849
you'd really like to be done early,

434
00:15:54,929 --> 00:15:57,219
but you know our playtimes are for 50 minutes.

435
00:15:58,770 --> 00:16:01,919
We just reassure them and remind them of what they know.

436
00:16:02,469 --> 00:16:04,840
They're hitting the wall because of

437
00:16:05,369 --> 00:16:05,770
avoidance,

438
00:16:05,809 --> 00:16:06,489
resistance,

439
00:16:06,609 --> 00:16:07,400
hesitance,

440
00:16:07,669 --> 00:16:08,330
difficulty.

441
00:16:09,179 --> 00:16:10,150
That's not

442
00:16:10,440 --> 00:16:12,969
what they're asking for is not at the heart of what's going on.

443
00:16:13,479 --> 00:16:14,830
At the heart of what's going on,

444
00:16:15,000 --> 00:16:16,070
they don't feel ready

445
00:16:16,400 --> 00:16:17,270
and they'll get there,

446
00:16:17,919 --> 00:16:20,150
but we're going to remain adherent no matter what.

447
00:16:20,359 --> 00:16:21,869
That's a really important piece of this.

448
00:16:22,650 --> 00:16:23,250
So Mackenzie,

449
00:16:23,280 --> 00:16:24,840
I hope that that is helpful to you.

450
00:16:25,159 --> 00:16:26,349
Hello to all of my

451
00:16:26,599 --> 00:16:27,630
Illinoisans.

452
00:16:28,039 --> 00:16:29,200
Hope that's how you say that.

453
00:16:30,049 --> 00:16:31,520
Florida is so hot y'all still.

454
00:16:31,570 --> 00:16:33,809
I was on a discovery call this morning and she said,

455
00:16:33,890 --> 00:16:33,989
oh,

456
00:16:34,010 --> 00:16:35,080
it's like 60,

457
00:16:35,250 --> 00:16:36,520
and she was like in a sweater

458
00:16:36,809 --> 00:16:37,640
and I'm like,

459
00:16:37,770 --> 00:16:39,770
it's still 95 here.

460
00:16:39,849 --> 00:16:42,330
So I'm really hoping that we get cooler weather soon.

461
00:16:42,409 --> 00:16:46,580
I'm hoping that in Illinois you all actually have some sort of fall weather going on.

462
00:16:47,010 --> 00:16:49,289
We never know at Halloween

463
00:16:49,609 --> 00:16:51,809
whether we're still gonna be in the 90s or

464
00:16:51,809 --> 00:16:54,049
whether it'll be a little bit cooler for Halloween.

465
00:16:54,299 --> 00:16:55,450
And that's 2 months from now,

466
00:16:55,530 --> 00:16:56,969
so I've got so long to go.

467
00:16:57,049 --> 00:16:57,239
It's,

468
00:16:57,250 --> 00:16:58,190
it's crazy.

469
00:16:58,440 --> 00:17:00,320
We're we're working on getting cool around here.

470
00:17:00,400 --> 00:17:01,890
It is not even close yet though,

471
00:17:01,960 --> 00:17:04,920
so I hope some of you all are enjoying some cooler fall weather.

472
00:17:05,489 --> 00:17:05,608
All right,

473
00:17:05,810 --> 00:17:06,209
love y'all.

474
00:17:06,329 --> 00:17:06,729
Thanks so much.

475
00:17:06,829 --> 00:17:07,848
If you want to reach out to me,

476
00:17:07,930 --> 00:17:10,118
please do brenna@thekidcounselor.com.

477
00:17:10,130 --> 00:17:10,969
We'll talk again soon.

478
00:17:11,150 --> 00:17:11,329
Bye.

479
00:17:12,458 --> 00:17:15,318
Thank you for listening to the Play Therapy Podcast with Dr.

480
00:17:15,479 --> 00:17:16,398
Brenna Hicks.

481
00:17:16,558 --> 00:17:18,519
For more episodes and resources,

482
00:17:18,638 --> 00:17:23,398
please go to www.playtherapypodcast.com.