340 | "I Hate This and I Hate You": Trust the Process When Kids Push Back in Play Therapy

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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 Liba in Pennsylvania.

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And this is about a specific child with whom she's working,

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high levels of anxiety and diagnosis of ADHD.

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And just some concerns about some different facets of that work.

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So,

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thank you,

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Liba for the question.

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I'm excited to dive into this.

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Before I get there,

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I want to let you all know

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that

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the podcast meetup is taking place on October 11th

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in Houston.

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Several blocks from the conference hotel.

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So I would love to have you there.

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I would love to meet you.

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I would love to hug you.

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I would love to hang out with you.

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So if you are going to be able to make it,

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please let me know.

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There will be a link in the show notes and you can RSVP for that.

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I'm,

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that's one of my favorite things throughout the year is doing meetups,

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so I'm really looking forward to that.

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Please try to

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get to Houston so that we can hang out.

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All right,

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so let me read parts of Liba's email and then we will dive in together.

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I have a kid who from the moment he arrived was questioning how the therapy works

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and why it will work for him,

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and he is 8.

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Having high anxiety and intense ADHD,

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it makes a lot of sense that he wants information

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and to feel a level of control over the situation.

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In the beginning,

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I empathized with him.

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Hmm,

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this just doesn't make sense,

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which was not only helpful to him but incredibly infuriating.

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To the point of throwing things at me,

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running out of the room constantly,

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hated that I would not directly answer questions,

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that I noticed his feelings or what he was doing,

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and essentially every part of the process.

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With consistent limit setting,

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I'm able to navigate those behaviors,

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but a strong distaste for me and the therapeutic process as a whole emerged,

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and he's in a constant state of distress from the drop off,

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pleads with me to leave the entirety of the session.

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My acceptance and being with attitudes are seen as unhelpful,

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especially due to his rejection of me.

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I tried to make the space more comfortable for him by

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instructing his mom to bring with him a toy from home

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because in the previous session he screams that he hates all

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the toys here and wished that he had toys from home,

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but I got similar results

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after a particularly emotional session where he refused to leave

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the room and due to having a client afterwards,

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I could not utilize as much time and patience as I wanted,

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forcing me to provide him the choice of leaving on his own or with his father.

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I realized I had to change something as he

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was begrudgingly being convinced to go with his dad.

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The next session we met before his mom came back with us as a comfort measure,

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and I explained the therapy to him in child appropriate language

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that when you get to be by yourself and make your own decisions,

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a lot of time things get easier

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and kids feel less afraid.

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And he agreed to give

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4 times

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with the caveat that I would answer any questions he liked

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for the first or last 5 minutes of each session,

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and he could choose the timing of that.

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That first session was game changing.

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My hunch is probably due to his increased sense of control,

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and a smidge of therapeutic alliance was emerging.

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The session afterwards,

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however,

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we went back to how things were were in the beginning.

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He stated how this was dumb.

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It doesn't work.

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He isn't less afraid how much he hates me.

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And when I would try to accept these feelings,

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he would scream at me to shut up and that

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he doesn't want me to say his thoughts or feelings.

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Even when I tried more casual reflections that weren't using your feeling,

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such as it sucks,

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he would get so mad,

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so I respected his clear messaging for space and was present with him but silent.

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He said at the end of the second session that he hates this so much and doesn't want

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to finish the 4 he agreed to that it wasn't a fair agreement and I can't make him.

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These behaviors are in fact deeply connected to his presenting concerns,

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bringing him to therapy,

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but I'm left wondering if CCPT is a good fit for

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this particular client or if I'm missing or doing something wrong.

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OK,

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wow,

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Liba,

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that is quite

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a client.

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And we've all had them,

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we've all been there,

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so

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we,

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we empathize for sure.

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All right.

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So there's a lot to unpack here and I'm just going to kind of go in order of arrival.

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So this isn't really prioritized.

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I'm just going to share thoughts reading through that email.

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First and foremost,

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we know

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that kids with high levels of anxiety,

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their way of handling the anxiety

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is taking control over as much as they can control.

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So you were spot on with your perspective that it

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made sense because he wanted a level of control.

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Absolutely.

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We also know that highly anxious kids

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are likely to have really high levels of resistance.

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So we have comorbidity of need for control

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in highly anxious kids as well as very high levels and intense levels of resistance.

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With high anxiety,

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so you're seeing both

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this is normal this is expected

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this is something that we can look at and

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recognize immediately as a control issue.

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So at the very least,

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hopefully that will alleviate some of the concerns because this is

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a standard part of working with a highly anxious child.

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So

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when he comes in,

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And

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gets frustrated.

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Then starts behaving

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to show you how desperate he feels.

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So he is

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throwing things at you,

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running out of the room,

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all of that.

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That's his pushback.

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He feels overwhelmed.

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He feels out of control internally,

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and children will show outwardly how they're feeling inwardly.

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So he wants you to understand how awful he feels,

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and he's going to try to grasp at any measure that he can,

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which he has control over his behavior

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and it's not a cognitive control.

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He's just aware

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that

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he feels really badly and so he's going to behave how he chooses.

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That's one of the five things over which kids have control.

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And

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I also suspect since this is very early on in the process,

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he doesn't trust you,

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he doesn't have rapport or relationship with you yet.

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You're essentially a stranger to him

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and what he has proven again and again because

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this is a standard part of anxious children.

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They learn if I escalate,

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if I ramp up,

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if I make demands,

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if I get out of control,

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if I get this to a point where no one else can take it,

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I get my way.

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This is the way that anxious children learn to function.

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They condition everyone around them

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to do what they want

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to avoid the meltdown,

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to avoid the tantrum,

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to avoid the throwing,

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to avoid the running,

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so everyone kowtows to anxious children,

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everyone concedes around anxious children.

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Everyone gives in to anxious children.

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Everyone in an anxious child's world

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essentially learns to walk around on eggshells.

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And when that is taking place,

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then obviously the child is conditioned.

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Well,

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if this little bit of escalation didn't work,

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I have to ramp it up.

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Oh,

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that didn't work,

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I have to ramp it up again.

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And everything continues to spiral.

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So in people's best intentions

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of I just wanna keep them calm.

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I just wanna keep them happy.

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I don't want them to feel really anxious and overwhelmed,

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so I'll do whatever.

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It actually begets the cycle where things get worse and worse and worse,

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and the child never actually confronts their anxiety,

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which means they just learn to avoid it,

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which also resets the spiral.

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So it's a really unfortunate pattern.

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But again,

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very normal,

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Liba.

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I'm,

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I'm hoping that you're going to recognize as we go through this,

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everything you're describing is expected and a part of the process.

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So

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when you

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let his mom have him bring a toy.

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That is a helpful

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realization.

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He was saying he didn't like the toys and he

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wished that he could have brought something from home.

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But let me be real clear.

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And I've actually talked about this on coaching calls quite a bit.

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It is never about what the child is insisting that it's about.

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So when he's screaming that he hates your toys and he wishes he had a toy from home,

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that's not actually what's going on for him.

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He doesn't actually hate your toys.

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He doesn't actually wish that he had a toy from home.

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That's a verbal representation of I'm just trying to get myself out of this mess.

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And so when you have that pattern of behavior,

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we can't get caught up in what the child is saying

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we have to recognize there's something deeper going on

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and therefore,

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when he brought the toy the next time,

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it didn't solve the problem,

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of course it didn't.

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When you conceded and said,

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OK,

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I'll ask questions for you for the first or the last 5 minutes,

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that didn't solve the problem either.

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When mom came back with him,

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that didn't solve the problem either.

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You can see his demands

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and what he's insisting.

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They're just grasps at ways to solve the high level of worry and fear and anxiety

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that are swirling around inside of him.

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That's never the solution.

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For my coaching folks,

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it's never about the two.

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You all know what I mean.

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So

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I think it's really important,

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Liba to recognize when you said he can bring a toy from home,

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that was your attempt at accommodating his needs,

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but his need was not to have a toy from home.

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His need was to avoid

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how uncomfortable and awkward it feels

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to go and have to face your junk.

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So

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that is what kind of unfolded there.

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And then

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when you had that session where everything seemed calmer,

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so you said that first session was game changing.

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He had an increased sense of control

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and a smidge of Therapeutic alliance was emerging.

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Of course you're only in your first few sessions,

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so the more sessions you have,

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the more relationship is built.

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That absolutely would be a contributing factor,

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but you also.

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Talk to him about how many times he would come.

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That was concrete.

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00:10:19,450 --> 00:10:21,789
So he chose to come 4 more times

269
00:10:22,359 --> 00:10:26,429
that gave him a sense of knowledge of what's to come and what to expect.

270
00:10:26,679 --> 00:10:28,390
You said you would ask,

271
00:10:28,440 --> 00:10:28,799
are you sorry,

272
00:10:28,880 --> 00:10:30,190
you would answer questions

273
00:10:30,440 --> 00:10:32,309
for the first or the last 5 minutes.

274
00:10:32,520 --> 00:10:33,950
He felt that he had

275
00:10:34,359 --> 00:10:36,390
sway over the session,

276
00:10:37,000 --> 00:10:38,270
but it was short lived.

277
00:10:38,869 --> 00:10:41,530
It only addressed something temporarily.

278
00:10:41,609 --> 00:10:42,000
Why?

279
00:10:42,270 --> 00:10:43,880
Because the anxiety is still there,

280
00:10:44,489 --> 00:10:46,359
because the need for control is still there,

281
00:10:46,729 --> 00:10:49,340
because the paralyzing fear is still there,

282
00:10:49,650 --> 00:10:52,479
because the junk he needs to work through is still there,

283
00:10:52,570 --> 00:10:55,080
resistance is still rearing its ugly head,

284
00:10:55,250 --> 00:10:56,440
and so on and so on.

285
00:10:56,690 --> 00:10:59,289
So the fact that you had that temporary respite.

286
00:11:00,359 --> 00:11:01,809
That's what always happens.

287
00:11:02,159 --> 00:11:03,229
People give in,

288
00:11:03,880 --> 00:11:05,989
they get this little bit of relief,

289
00:11:06,400 --> 00:11:08,599
and then they're right back into the spiral again,

290
00:11:08,919 --> 00:11:11,030
which is what he's showing again and again.

291
00:11:11,320 --> 00:11:12,549
So when you said

292
00:11:13,239 --> 00:11:14,599
he would scream at you to shut up,

293
00:11:14,679 --> 00:11:15,719
we all have been there,

294
00:11:15,789 --> 00:11:15,890
and,

295
00:11:15,909 --> 00:11:18,059
and I know none of y'all can see each other,

296
00:11:18,119 --> 00:11:21,750
but raise your hand if you've had a child tell you to shut up in a session.

297
00:11:22,770 --> 00:11:25,010
I know all of you just raised your hand

298
00:11:25,479 --> 00:11:27,390
because this is the nature of CCPT.

299
00:11:27,799 --> 00:11:29,150
So we are told to shut up,

300
00:11:29,320 --> 00:11:30,630
we are told to not talk.

301
00:11:30,799 --> 00:11:32,359
We are told to

302
00:11:32,719 --> 00:11:35,039
be quiet and don't say one more thing to me.

303
00:11:35,159 --> 00:11:36,349
Don't tell me how I feel.

304
00:11:36,440 --> 00:11:37,549
Don't tell me what I'm doing,

305
00:11:37,719 --> 00:11:39,020
don't tell me what I'm thinking.

306
00:11:39,440 --> 00:11:39,840
All right,

307
00:11:40,000 --> 00:11:41,270
it's a control grab.

308
00:11:41,559 --> 00:11:42,590
It's for power.

309
00:11:43,539 --> 00:11:46,869
They need to feel that they get to do something

310
00:11:47,030 --> 00:11:49,700
other than be at the mercy of the environment.

311
00:11:50,349 --> 00:11:53,419
That is a very common process when you said

312
00:11:53,710 --> 00:11:54,460
that

313
00:11:55,030 --> 00:11:59,140
you respected his message for space and you were present but silent.

314
00:12:00,440 --> 00:12:01,640
I've talked about this a lot.

315
00:12:02,039 --> 00:12:03,469
We cannot do our job.

316
00:12:04,429 --> 00:12:05,940
Unless we speak.

317
00:12:07,429 --> 00:12:07,659
Yes,

318
00:12:07,710 --> 00:12:09,859
the relationship supersedes everything,

319
00:12:10,030 --> 00:12:14,190
so there is power in just being with a child and I don't mean to be with attitudes.

320
00:12:14,270 --> 00:12:15,700
I mean just being with,

321
00:12:16,030 --> 00:12:16,859
being present,

322
00:12:17,030 --> 00:12:18,020
being engaged,

323
00:12:18,229 --> 00:12:19,789
being a part of the session,

324
00:12:20,070 --> 00:12:20,539
of course,

325
00:12:20,590 --> 00:12:23,419
there's value in that and the relationship is still there.

326
00:12:24,679 --> 00:12:25,150
But

327
00:12:25,320 --> 00:12:26,909
the way that a child

328
00:12:27,570 --> 00:12:29,109
understands what's happening,

329
00:12:29,159 --> 00:12:30,840
the way that a child processes,

330
00:12:30,919 --> 00:12:33,000
the way that a child experiences,

331
00:12:33,239 --> 00:12:34,469
what they're working through.

332
00:12:35,150 --> 00:12:38,940
is in part because of our therapeutic engagement verbally.

333
00:12:39,690 --> 00:12:41,770
That's why we have reflective responses.

334
00:12:41,890 --> 00:12:43,650
That's why we have pillars.

335
00:12:43,729 --> 00:12:48,320
That's why we have techniques because it facilitates self-actualization.

336
00:12:48,650 --> 00:12:51,169
We can't do our jobs if we say nothing.

337
00:12:52,650 --> 00:12:53,619
And therefore,

338
00:12:53,669 --> 00:12:55,520
even when a child tells us to shut up,

339
00:12:55,640 --> 00:12:57,789
even when a child tells us not to talk,

340
00:12:58,479 --> 00:13:00,549
we have to slow down the pace,

341
00:13:00,760 --> 00:13:03,429
we have to slow down the frequency,

342
00:13:03,799 --> 00:13:05,909
we have to slow down the tone,

343
00:13:06,229 --> 00:13:07,539
so we might whisper

344
00:13:08,280 --> 00:13:11,349
and we may go 30 seconds before we say something,

345
00:13:11,599 --> 00:13:13,830
and we talk slower and gentler

346
00:13:14,280 --> 00:13:16,549
because the child does not want us to talk.

347
00:13:17,500 --> 00:13:19,299
But we can't say nothing.

348
00:13:20,140 --> 00:13:23,820
Because then we're not engaging in a therapeutic way

349
00:13:24,020 --> 00:13:26,020
with dialogue that a child needs.

350
00:13:27,099 --> 00:13:30,690
So a lot of us struggle with that because I was told not to talk.

351
00:13:31,059 --> 00:13:31,260
Yes,

352
00:13:31,419 --> 00:13:33,469
but kids also tell us to

353
00:13:34,179 --> 00:13:37,630
handcuff ourselves to something and stay like that for 100,000 years.

354
00:13:38,549 --> 00:13:40,140
Kids also tell us that

355
00:13:40,530 --> 00:13:44,039
you are the stupidest human on this planet and I never wanna see you again.

356
00:13:44,250 --> 00:13:45,979
We don't believe that to be true either.

357
00:13:46,729 --> 00:13:47,169
So

358
00:13:47,609 --> 00:13:50,489
we have to recognize it's a power and control grab.

359
00:13:51,320 --> 00:13:53,960
And when kids tell you to stop talking and shut up,

360
00:13:54,090 --> 00:13:55,849
and if you say one more thing to me,

361
00:13:55,929 --> 00:13:56,890
I'm going too.

362
00:13:58,059 --> 00:13:59,929
Our role is to respond.

363
00:14:00,460 --> 00:14:02,250
We adjust our responses,

364
00:14:02,419 --> 00:14:03,409
but we respond.

365
00:14:04,630 --> 00:14:05,400
And then of course,

366
00:14:05,479 --> 00:14:07,909
it does not surprise me at all that he says

367
00:14:08,159 --> 00:14:11,869
he hates this so much and he does not want to finish the 4 that he agreed to.

368
00:14:12,119 --> 00:14:12,419
Why?

369
00:14:12,719 --> 00:14:14,479
Because he agreed to the 4

370
00:14:14,919 --> 00:14:17,070
when he felt that he could handle it

371
00:14:17,440 --> 00:14:19,880
and he's realizing that he absolutely can't handle it.

372
00:14:20,679 --> 00:14:22,190
So now he's backpedaling,

373
00:14:22,799 --> 00:14:26,950
but the beauty of CCPT and the beauty of the process is

374
00:14:27,440 --> 00:14:28,900
that he chose

375
00:14:29,330 --> 00:14:30,469
to do 4 more.

376
00:14:30,960 --> 00:14:32,419
You have set appointments

377
00:14:32,719 --> 00:14:35,039
and you're going to sit in the pocket of his

378
00:14:35,039 --> 00:14:38,200
discomfort and you're going to sit in the emotion and

379
00:14:38,200 --> 00:14:41,270
the experience and the resistance and the power and control

380
00:14:41,270 --> 00:14:44,000
and the anger and all of this stuff with him.

381
00:14:44,789 --> 00:14:47,090
And he's going to continue to come.

382
00:14:47,500 --> 00:14:48,010
And

383
00:14:48,219 --> 00:14:49,690
parents need to reinforce that,

384
00:14:49,739 --> 00:14:51,409
you need to reinforce that.

385
00:14:51,859 --> 00:14:53,299
You know that when you get here,

386
00:14:53,460 --> 00:14:55,400
you get to decide what happens.

387
00:14:55,859 --> 00:14:58,320
I'm gonna see you next week on Tuesday at 4.

388
00:14:59,190 --> 00:15:01,169
And you get to decide what happens.

389
00:15:02,419 --> 00:15:05,090
Meaning the appointment is non-negotiable,

390
00:15:05,619 --> 00:15:08,409
but whether you choose to play or whether you choose to talk,

391
00:15:08,500 --> 00:15:10,289
whether you choose to come into the playroom,

392
00:15:10,500 --> 00:15:13,289
whether you choose to say you hate me for 50 minutes straight,

393
00:15:13,979 --> 00:15:16,609
whatever happens once he's there,

394
00:15:16,940 --> 00:15:19,650
that is completely up to him under his control,

395
00:15:20,059 --> 00:15:23,210
but coming to the session is a standard part of the week.

396
00:15:24,460 --> 00:15:26,770
So in answer to your final question.

397
00:15:27,940 --> 00:15:31,979
They're connected his behaviors are connected to his presenting concerns.

398
00:15:32,299 --> 00:15:33,130
Of course they are,

399
00:15:33,299 --> 00:15:35,010
because kids know what they need to work on

400
00:15:35,299 --> 00:15:36,460
and they can't avoid it.

401
00:15:36,830 --> 00:15:39,530
So everything that he is struggling with is coming up.

402
00:15:39,659 --> 00:15:41,210
That's why it's upheaving him.

403
00:15:41,380 --> 00:15:42,489
That's why it is

404
00:15:42,940 --> 00:15:44,659
jerking the rug out from underneath him.

405
00:15:45,710 --> 00:15:48,729
And then you're left wondering if CCPT is a fit for him.

406
00:15:49,080 --> 00:15:50,900
100%

407
00:15:51,099 --> 00:15:51,650
yes.

408
00:15:52,640 --> 00:15:53,950
Any other model,

409
00:15:54,159 --> 00:15:56,510
any other theoretical modality

410
00:15:56,760 --> 00:15:58,869
is going to force him to do stuff.

411
00:15:59,729 --> 00:16:00,780
You need to talk to me,

412
00:16:00,929 --> 00:16:02,039
you need to do a worksheet,

413
00:16:02,169 --> 00:16:03,520
you need to do an activity.

414
00:16:03,770 --> 00:16:05,159
We need to do deep breathing.

415
00:16:05,330 --> 00:16:07,530
We're going to do the anger monster sheet.

416
00:16:07,570 --> 00:16:08,169
We're going to,

417
00:16:08,210 --> 00:16:08,760
whatever.

418
00:16:09,530 --> 00:16:12,419
And the child is going to be forced

419
00:16:12,909 --> 00:16:13,989
into doing something.

420
00:16:15,000 --> 00:16:19,309
Which is going to create more resistance and more anxiety and more overwhelm.

421
00:16:20,340 --> 00:16:22,210
And being given the time,

422
00:16:22,250 --> 00:16:22,609
the tools,

423
00:16:22,619 --> 00:16:25,619
and the opportunity within the context of CCPT,

424
00:16:26,210 --> 00:16:29,359
he will actually address the anxiety at its root.

425
00:16:29,609 --> 00:16:30,919
It won't be superficial,

426
00:16:30,929 --> 00:16:32,239
it won't be high level.

427
00:16:32,450 --> 00:16:34,390
It won't be band-aid on the gaping wound.

428
00:16:34,450 --> 00:16:36,299
He will actually conquer

429
00:16:36,650 --> 00:16:37,039
the

430
00:16:37,489 --> 00:16:40,780
unmanageable levels of anxiety that he's experiencing

431
00:16:41,289 --> 00:16:43,010
as he goes through this process with you.

432
00:16:43,289 --> 00:16:43,940
So yes,

433
00:16:44,059 --> 00:16:45,739
100% it's appropriate.

434
00:16:45,969 --> 00:16:46,969
Stay the course

435
00:16:47,219 --> 00:16:49,609
and you are not missing or doing something wrong.

436
00:16:49,859 --> 00:16:51,330
Stay adherent to the model.

437
00:16:52,580 --> 00:16:54,849
Continue to engage therapeutically.

438
00:16:55,570 --> 00:16:57,210
Respect him where he is,

439
00:16:57,500 --> 00:16:59,219
unconditionally accept him.

440
00:17:00,119 --> 00:17:01,669
Set limits when necessary.

441
00:17:03,090 --> 00:17:04,348
Use the pillars,

442
00:17:04,608 --> 00:17:06,560
use the reflective responses.

443
00:17:06,930 --> 00:17:07,880
Be with him.

444
00:17:08,550 --> 00:17:10,010
And it will sort itself out.

445
00:17:10,380 --> 00:17:11,530
Trust the process.

446
00:17:12,410 --> 00:17:14,150
Trust the process always.

447
00:17:14,489 --> 00:17:15,319
Trust him,

448
00:17:15,650 --> 00:17:16,598
trust yourself,

449
00:17:16,930 --> 00:17:17,880
trust the model,

450
00:17:18,170 --> 00:17:19,098
trust the process.

451
00:17:20,420 --> 00:17:21,020
I love y'all.

452
00:17:21,209 --> 00:17:22,020
We'll talk again soon.

453
00:17:22,219 --> 00:17:22,459
Bye.

454
00:17:23,529 --> 00:17:26,288
Thank you for listening to the Play Therapy Podcast with Dr.

455
00:17:26,448 --> 00:17:27,409
Brenna Hicks.

456
00:17:27,529 --> 00:17:29,519
For more episodes and resources,

457
00:17:29,649 --> 00:17:34,389
please go to www.playtherapypodcast.com.