189 | The Power of Boundaries in Child-Centered Play Therapy: Managing Separation Anxiety

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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, I'm Dr. Brenna Hicks, The Kid Counselor.

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This is the Play Therapy Podcast where you get

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a master class and 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. I am answering a question from Jonathan

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and Jonathan has emailed in about a child dealing with separation anxiety

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and how to handle that.

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That can actually be quite tricky

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because there are a lot of components

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that actually help the child work through separation anxiety.

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But early on in the process, those components have not

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been factored in yet.

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So I'll read parts of his email and then I'll be able

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to talk through some thoughts and we'll kind of debrief that together.

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So he says

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the background information on the client is,

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the client has witnessed domestic abuse has had multiple custody arrangements

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as mother and father

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have been in and out of her life

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has two older siblings and currently lives with grandparents.

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Ok.

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So the scenario was I'm working with a new client,

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just completed session two in the initial session,

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the client enjoyed her time in the playroom,

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explored all the toys and engaged in some power and control

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play as she spent time handcuffing me and a baby doll.

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However, in session two,

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the client immediately went back to the doll handcuffing it,

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shooting it with a dark gun and then sat at the table with some play doh

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and began to cry for her nana.

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I reflected her feeling of being unsafe,

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wanting to see her nana and not wanting to play.

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I offered her a choice to go see her nana

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in the waiting room for one minute or two minutes.

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But she continued to cry saying she didn't want to be in the playroom.

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She eventually got up from the table and headed towards the door in which I reflected

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that she wanted to end her playtime and go see her nana once in the lobby,

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she clung to her nana and would no longer engage with me.

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Even as I tried to continue to complete the session,

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I took this as normal as she felt

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unsafe and had potentially just worked through something.

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But I was unsure what to do in the playroom.

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Once I realized she was not going to feel safe unless she left, left the session.

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I felt like I was hurting her by not allowing her to leave sooner.

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She cried for about five minutes before she left.

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Her grandmother seemed unsettled.

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But I had a follow up conversation explaining

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this was normal at the beginning of the process

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when children are dealing with separation anxiety in the playroom, what do we do?

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Ok, so Jonathan, I really appreciate this.

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I wanna give some overarching thoughts before

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I dive into some more specific details.

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So first and foremost,

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let's start with the fact that grandma was unsettled and

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you had a follow up conversation explaining and normalizing this.

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This is exactly how we handle this

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whenever something happens in the play session

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before the play session, after the play session.

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If there's a lobby session, if the child refuses to come back,

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if the child cries, if the child gets upset, if the child gets injured,

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it really doesn't matter what the out of the ordinary circumstance is. If something

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out of standard process takes place,

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we always want to follow up with parent or caregiver

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to explain what happened, explain why it was therapeutically necessary,

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explain that it's normal.

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We just want to reassure them that this is part of the

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process and they do not have anything to be concerned about.

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So that was handled very appropriately.

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And then my second thought is

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I actually did not notice this the first time I read this and reading it out loud, it,

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it popped into my head.

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So I'm kind of going off script here a little bit,

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but I think this is really important to talk about.

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So what I'm just now sensing as I reread this

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is that

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the child circumvented the stages and phases. And what I mean by that is

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week one child came in and did really deep work.

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The exploratory play is very normal and expected.

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So that really wasn't so much noteworthy. But

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the power and control play where she spent

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time handcuffing you handcuffing the baby doll.

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And then session two immediately went to the doll actually,

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then extended that play further.

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So not only handcuffed it like last time, but then shot it with a dart gun. OK.

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That is after an hour of knowing you essentially.

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And there was no initiation. There was no warm up. There was no safety established.

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There was no trust, no rapport, no relationship.

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Nothing was built

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in that one hour.

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So she dove in way too deep, way too fast, way too far.

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And when kids jump stages and phases,

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she didn't even hit resistance either. I mean, let's think through this.

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It's traditionally initiation resistance work.

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Well, she skipped two, went straight to work and now she's reeling from it.

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So we need to be really mindful that just like the stages of grief.

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Let's go back to Kubler Ross to our grad school days, right?

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Stages of grief. They don't always go in

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the little dab

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will do you order by the way, if you didn't learn that, that's always, always,

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always the way I remember the stages of grief.

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You can make an acronym out of it a little dab'll Do you. anyway,

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Look that up you'll figure it out,

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but

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you cannot walk around the stages, you have to walk through them.

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And it's the same thing in play therapy. So sometimes kids go in different orders,

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sometimes they skip and have to revisit and they

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go back and they backtrack and they jump ahead.

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So it's not always quote, 1 2 3 4.

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But in this case,

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I deeply believe that she dove straight into work and

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then by a few minutes into the second session,

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she was just like, whoa, I cannot do this, I cannot take this.

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This is too much. I don't even know this person.

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I, I don't feel safe here. I don't,

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I, I mean, that was just a lot for her to manage an hour into the process.

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So that is my off script commentary.

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Now,

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I'll get back to the points that I determined I

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was going to talk about in the first place.

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Ok.

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So let's start with

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the understanding that a child's play session is for the

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length of time that the child's play session is.

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And why I'm not being specific is because I

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know that ranges anywhere from 45 to 55 minutes.

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So I don't know exactly what your average time is.

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But let's say it's 50 minutes because that's what I do.

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You consistently remind the child that their play time is for 50 minutes

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and the 50 minutes are for staying in the playroom.

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So that is a very

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nonnegotiable component of play therapy.

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Now, had she not willingly come back to the playroom?

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Then we never force a child to go back and force them to stay in there for 50 minutes,

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but she willingly came back and then she got really upset

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because she was overwhelmed.

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So in that scenario, we would sit in front of the door with our chair

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as a natural barrier to leaving

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and we just continue to acknowledge that

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you really wish that you could go see your nana, but we still have 30 minutes left.

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You can choose to go see her as soon as our play time is over.

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So we would want to reassure the child over and over and over again

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that we've not reached the time

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from the play session to end yet.

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You really wish that you could go out and be with your nana.

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You really wish you would, you could go out and talk to nana.

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You really would like to go give nana a hug.

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You really would like to show nana something

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you really would like whatever the scenario is,

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but we still have X amount of time of our play time left.

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You can choose to do whatever she wanted to do when our time is up.

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So that's the way that you handle when a child is wanting to go out to the lobby,

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leave the session, et cetera.

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So a related component, one of the things that you typed here, Jonathan,

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you, when she moved toward the door,

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you reflected that she wanted to end her playtime early.

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Ok.

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So let's be really intentional about our words and make it very

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clear what the CCPT model does and does not,

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you can never earn playtime, you can never lose playtime

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and play sessions are never ended early because

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of what's going on in the play session.

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Now, of course, there are caveats because if a child gets hurt,

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you're not going to continue to do a play session.

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I mean, like, truly hurt like they need stitches or they have a huge bump on their head

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or they broke an arm or whatever.

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I mean, obviously you're not going to continue a session. So

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extreme outliers aside,

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you

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reassure the child that

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we have time left to play and our play time is for staying in the room.

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They can't end it early,

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they can't earn it or lose it.

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And

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Landreth model says that

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the child's play time is the child's playtime. The Cochran's model,

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they use ending playtime early as a consequence for behavior.

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And that is not the way I was trained and that is not something I have ever done.

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So I just wanna make that really clear that we would not say, oh,

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you're choosing to end your playtime early because that's a slippery slope.

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As soon as the child believes that they have a

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choice to only stay in the room for five minutes,

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for example.

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Ok, I choose to be done and you're five minutes in,

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you will never be able to rein that choice back in.

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So choosing to end early and,

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or earning it or losing it is never the CCPT Landreth trained way.

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All right.

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So I wanted to make that really clear as we were talking about blocking the door.

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Ok.

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So I wanna bring up another point unless she explicitly said

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that she felt unsafe,

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which it doesn't sound like she did Jonathan based on what you said,

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but maybe she did in fact communicate that and

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you just didn't make that known in the email.

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But several times you mentioned reflecting her feeling of being unsafe.

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Unless that was clearly communicated,

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we want to be really careful with making assumptions like that.

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You could have acknowledged that she felt uncomfortable.

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You should have acknowledged that she felt lonely.

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You could have acknowledged that she wanted to go see her nana.

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You could have acknowledged that she was upset.

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All of those are concrete and visibly

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noticeable,

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but unsafe is a little bit presumptive.

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So unless there was some verbal or non verbal

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indication that that was truly what she felt,

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then we would not want to say that because we need to be very

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concrete with what we're observing and what we can factually say to a child.

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So unsafe would be a little bit too far in the

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I'm kind of giving my take on what you might be feeling rather

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than this is evidenced by your behavior or what you've said to me.

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So, just as a general rule, we want to make sure that anything we reflect,

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we can very factually say that because it's evident, not because we're guessing.

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Ok. And then another thought, obviously this is an attachment issue at

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its core, right? I mean, we, we can go back and say she skipped stages and

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and then she was kind of reeling from it and didn't know how to handle it. So

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that's catalyst.

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But at its root, we understand this is an attachment issue.

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She has had multiple custody arrangements,

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meaning she doesn't really have secure attachment.

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So mom's out of the picture in and out, dad's out of the picture in and out, she's been

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under the custody of multiple different people.

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Now she's living with grandma and grandpa,

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she's been a witness of domestic abuse.

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So you can see how

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the one constant,

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the one source of comfort,

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the one stability in her life is probably her grandmother.

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And obviously it was an attachment rooted issue.

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But you can see that it was actually a cry for comfort.

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She wanted to be comforted by her grandmother because she was really upset.

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So

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while we can see the attachment, we can see separation anxiety to a degree.

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But we understand there's a much deeper

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issue in

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this scenario.

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So

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here's what I think is the trickiest part of this, Jonathan,

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you didn't have a relationship with this client yet.

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You were an hour or so in to your work with her.

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So in a further along in the journey, client,

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even if a client is crying, even if a client is upset, even if a client needs comfort,

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even if a client is overwhelmed emotionally,

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the relationship is already established.

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And therefore the safety and security are also a component of that

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in this particular instance,

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because it was the second session early on in that session,

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it's a little bit harder to really stick to that.

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You really wish you could go see your nana, but we still have 25 minutes left.

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You can choose to go see her when we're all done.

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That is a lot harder because the client,

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we,

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we kind of have this sense that the client shouldn't suffer when

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they have no one in the room that they feel connected with.

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So in this particular case,

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I would have actually amended your choice a little bit because you gave her a

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choice to go see Nana in the waiting room for one minute or two.

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But as soon as the child leaves the playroom,

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there's a really good likelihood they're not gonna come back to the playroom.

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So I would have actually give, made her,

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I would have given her the choice

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that nana can come back to the playroom for one minute or two minutes,

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which does she choose,

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you really wanna see Nana.

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I wonder if you choose for her to come back for one minute or two minutes.

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So then Nana comes back to the playroom and then

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when the one or two minute and of course,

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she's gonna choose two minutes, right?

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So then

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when the two minutes are up,

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Nana just walks out the door and shuts it and you are

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sitting right next to the door so the client cannot follow.

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So then the client was able to have the comfort, have the connection.

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Make sure that grandma's still there,

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make sure that she's going to be there when the

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session is over a little bit of a check in.

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But it doesn't involve you leaving the playroom with the client,

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which is going to make it much trickier to get

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back into the playroom when the child is that upset.

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And here's why I want to touch on one final point. You said

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I felt like I was hurting her by not allowing her to leave sooner. Ok. So

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I've heard that sentence from so many therapists in so many different ways.

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I'm going to

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rework that premise for you, Jonathan.

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We are never hurting a child.

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Nothing that we do that's therapeutically adherent to CCPT ever hurts a child.

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When we set limits

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the child can get upset, the child can get angry, the child can cry,

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the child can be very deregulated,

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we're not hurting them.

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We are never doing anything to hurt a child when we use CCPT skills.

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So in that moment, when you said I didn't allow her to leave sooner,

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she could have had a choice of a

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parameter that you were OK with

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Nana coming back to the playroom, for example.

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But the choice of leaving the playroom early before the

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session is over is not one of the choices.

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One of the non negotiables is that the playroom is

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where you stay for the entirety of your playtime.

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So if it's a 50 minute session,

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the child is back there for 50 minutes with you, that's non negotiable.

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That's how the work is done.

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And so

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I wanna kind of help you re retool the way that you were feeling,

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you were not hurting her and it wasn't that you were not allowing her to leave.

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You were setting limits on what the expectations are.

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And here's why this works because kids need to learn how

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to work out their own emotions and their own experiences.

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They can't be rescued, they can't be protected,

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they can't have someone swoop in and just let them avoid what they they need to face.

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She was really, really deregulated, which means she has no emotional vocabulary,

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which means she has no coping skills, which means she has no resilience

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and two sessions. And of course she doesn't, she hasn't built those yet.

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But the only way she builds them is if she's given opportunities to build them.

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So that was actually a very therapeutically valuable thing for

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her to sit there with how big her feelings were.

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And for you to reflect those and for you to validate and to,

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for her to feel understood,

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those were all actually very helpful things not hurtful.

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So we have to make sure that we're approaching these situations with

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the mindset

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of when we are adherent to CCPT, we are only ever helping the child.

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They may not like it. They may not feel like it.

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They may get really, really upset,

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but

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that is actually their way of building the tools and the skills that they need

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when they get to practice those things.

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So Jonathan really thanks so much for the email.

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I hope that was a help to all of you because

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it's always tricky when a child is crying in our playroom.

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It's always tricky when a child says that they have to go out and see a loved one.

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I just wanna give them a hug. I just need to see if they're sitting out there.

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I mean, those are difficult conversations and moments in play sessions. So

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really appreciate you emailing in Jonathan.

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If you have a question or something for me,

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please reach out brenna@thekidcounselor.com.

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Love y'all. We'll talk again soon. Bye.

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Thank you for listening to the Play Therapy Podcast with Dr

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Brenna Hicks for more episodes and resources.

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Please go to www.playtherapypodcast.com.