191 | Beyond the Diagnosis: How Child-Centered Play Therapy Supports Children with Various Conditions and Diagnoses

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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 a master class in child-centered,

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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 Bailey in Texas

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and Bailey's question is about the efficacy of CCPT with children with NF1.

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And for those of you that are not familiar with NF1, it's a genetic condition

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and I'm actually going to enlarge that a little bit to

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all kinds of disorders and diagnoses of the sort

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so that I can make it a little bit more universal liable if that's a word.

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But I just want to kind of talk through when a child has been diagnosed with

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a disorder,

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any kind of disease

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that how that typically impacts the process,

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what they're presenting issues usually are and we'll

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just kind of process some considerations together.

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So

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I will read parts of Bailey's email and then we'll dive in together.

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I'm wondering about the efficacy of CCPT for children with NF1 I've looked,

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but I can't find much research around

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play therapy and this specific genetic condition.

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I have a client that is six years old

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with NF1 and her challenges all look like ADHD.

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I can see how therapy is helping her with impulse control, empathy,

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executive planning and relational skills.

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However,

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I want to know the realistic expectations that parents and I can set up with

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her struggles and how much play therapy

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can realistically help with this genetic condition.

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The client's parent reports that the client's behavior is much

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better when she's compliant with ADHD meds.

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However, getting her to be compliant and take the meds has been a challenge for them.

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All right, Bailey, thank you so much.

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And by the way,

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I see on your email that you're under the supervision of Brittany Wilson,

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Small World Brittany and I both won

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the doctoral research award the same year.

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And so APT awarded both of us for

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our doctoral research in play therapy the same year.

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So we were at the awards banquet together

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and we were presented with awards together.

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So

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I actually am familiar with Brittany.

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So tell her I said hello and it's nice to see that you're under her supervision.

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Ok. So let's dive into this. So let's start off with a

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couple of thoughts before we look at some specifics.

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First of all, it's really interesting,

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you mentioned that her challenges all look like ADHD.

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Ok.

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I was actually just this week we were in the coaching programs, we were talking about

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the most common diagnoses and just some considerations about that.

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And I refer to ADHD as the blanket, catch all diagnosis.

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And what I mean by that is

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the diagnostic criteria

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and the symptoms that are associated with ADHD

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are

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obviously tied to that disorder.

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Yet they can be explained why away by 100 other reasons.

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So you have distract ability.

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Well, that could be ADHD or it could be addiction to screens.

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You have inability to focus and impulsivity,

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that could be ADHD or it could be dysregulation.

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You have anxiety factor in, you have

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lack of emotional vocabulary factor in you have

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a lack of emotional regulation. I mean,

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no emotional vocabulary. The list goes on and on and on.

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So often kids come in and they have been diagnosed with ADHD or they

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look the same as diagnostic criteria

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for ADHD.

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But there are

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so many other reasons why those behaviors would be presenting.

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And so when we look at the whole child,

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we can usually see that it is not ADHD, it is in fact something else.

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So I thought that was really interesting that you said her challenges

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all present like ADHD because that's exactly what happens.

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We meet diagnostic criteria. But ADHD is actually not a valid diagnosis.

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So that's something we need to be really mindful of when kids come in with ADHD

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diagnoses and or if the parent is considering having them tested for ADHD.

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My standard response is let's address everything else going on

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in the child's life through child center play therapy.

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And then we'll re evaluate whether or not

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we still feel like diagnostic criteria is met

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and it rarely if ever is still met after they go through a course of play therapy.

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So

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I wanted to throw that out there before we dive in. Ok.

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So let's start with

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my disclaimer.

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I have not personally ever worked with a child with NF1,

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but I have worked with children with all kinds of

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genetic and congenital

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and physiological diagnoses and disorders and things like that. So

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I'm going to generalize this a little bit and make it a little more universal. But

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I think this will still apply to your specific client Bailey with NF1.

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So any diagnosis in childhood,

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any medical complication,

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any congenital defect disorder disease,

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anything that makes a child physiologically different

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from their peers,

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it

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causes issues for the child.

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They know they're different, they don't know why

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or if they do know why they resent that they're different.

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They resent that things come easier to other kids.

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They resent the challenges that it creates,

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they resent the fact that they struggle and other kids don't.

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They think that there's something wrong with them.

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They think that there's something bad about them,

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they usually turn to self blame, they turn to negative self talk.

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They actually become very, very critical of themselves.

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And it's all because they know

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that quote, I'm different.

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So when we have that kind of pressure

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from any kind of disorder or diagnosis or disease,

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we know that's going to weigh heavily on a child's self esteem.

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And when a child does not have an identity, when a child does not have value,

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self value anyway, I mean, all children inherently have value.

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But if a child doesn't believe that they have value or worth,

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they don't have any sense of who they are and they have very low self esteem,

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they behave in very self defeating ways.

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So we're very clearly aware that

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a child with a condition like NF1

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is absolutely going to have low self esteem

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and struggle behaviorally.

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That will just go hand in hand.

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Ok.

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When you specifically asked,

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I want to know the realistic expectations that you and the parent can set up.

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Well,

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I feel like that's a little bit of a slippery slope.

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So I'm going to answer that, but I actually want to kind of reframe it a little bit.

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So the child-centered approach

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does not go into treatment saying we're going to set up realistic expectations

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what it does. However, is it helps the parent understand what they can

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foresee for the child. And what they will gain as a part of the therapeutic process.

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So

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I think it's actually less about

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what's going to help with the condition

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and more about how play therapy is going to give the child what

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the child needs to better address everything that's going on in her life.

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So I think we need to be really intentional and careful about our

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language and about our phrasing and about our words that we use,

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especially when we meet with parents.

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Because if we say things like

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I want us to have realistic expectations

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that puts us in the driver's seat

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and it puts us with an agenda

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and it puts us with outcomes that we are looking for

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and that's no longer adherent to CCPT.

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So what we want to do instead

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is talk about how she's going to develop coping skills

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for everything that she faces.

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She will be a better able to face the NF1 condition.

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She will be better able to face, taking her medication.

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She will be better able to face social interaction with her peers.

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She'll be able to better interact relationally with her family members.

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She will be able to

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know that she can trust herself to handle things that come.

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Coping is a huge piece of the puzzle when it comes

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to any kind of condition that a child is dealing with.

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Because

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from what I understand anyway, NF1 is treatable but not necessarily curable.

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So this is likely something she's going to deal with the rest of her life.

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We're not trying to fix it.

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We're trying to give her coping skills so that she can better manage it.

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She will also build resilience.

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She will be tougher, she will be able to handle harder things

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as a result of the CCPT process.

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So when a child is more resilient,

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they

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are better equipped to handle anything that may come

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and she will develop problem solving skills.

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She will realize I can trust myself

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to navigate whatever comes my way,

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whether it's related to NF1 or not.

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So we kind of pivot away from setting realistic expectations

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to deal with the condition

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and we make the focus on what is she going to gain as a result of the play therapy

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journey.

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And that obviously

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leads to a pretty frank discussion about the four universal outcomes.

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Because regardless of a reason that the child starts play therapy,

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they will work on their own individual issues.

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So if a child is dealing with anxiety, they will work on anxiety in CCPT.

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If they are dealing with aggression, they will work on that.

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If they're dealing with power and control, they will work on that.

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Yet, regardless of presenting issues.

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And regardless of why a child starts the play therapy process,

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the four universal outcomes

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are consistent

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regardless of whatever the child specifically brings in.

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So that would certainly be something that you

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would want to bring up to Parents Bailey,

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here are the four universal outcomes. By the way, pop quiz. What are they?

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That one actually might be a tricky one.

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Some of you may not have been able to yell those four to me. So let me throw you a bone.

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They are increased emotional vocabulary,

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increased regulation,

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increased worldview and increased self esteem.

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And if you didn't know those or you don't know the details of that,

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please go back and listen to earlier episodes because

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we've talked through the four universal outcomes before.

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But here's why that matters because what parent wouldn't say?

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Wow, if my child has better self esteem, if my child has better regulation,

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if my child has a better emotional vocabulary

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and my child has an increased worldview,

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things would be so much better for my child

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and for our family and for my child's future.

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Those are things that we should have the parents' attention focused on.

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Look at what she's going to gain

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in spite of the NF1 diagnosis.

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Look at what she's going to be able to achieve and what she's going to be able to

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learn through this process.

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Those four universal outcomes are hugely important

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for kids that are struggling with any

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kind of disorder or disease that is not necessarily going to go away.

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I'm actually working with several children who have

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persistent and pervasive

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physiological conditions

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and the goal is not to,

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you know, address the condition,

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it is to make sure that they are set

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up to manage whatever comes related to the condition.

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And that is very important to parents.

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And then finally,

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your last little bit of that is how much

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play therapy can realistically help with the condition.

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Again, I think

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I can answer the question but I'm going to reword it a

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little bit because play therapy is not going to help with the condition.

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The condition is genetic, the condition is not going to go away.

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So play therapy will not actually help with the condition at all.

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But play therapy is going to help your client

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totally perceive everything about her life differently.

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She will be more in control, she will be more regulated.

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She will have an emotional vocabulary, she will have coping,

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she will have resilience, she will believe in herself, she will trust herself,

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she will develop an identity, she will increase her confidence,

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she will feel more competent and I can go on and on and on.

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These are all of the things we see as kids work through issues.

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So those are the

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outcomes that play therapy is going to afford your client

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completely unrelated to the condition really.

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And

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so the goal when we are dealing with something

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that is likely not going to change or improve,

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and this can be actually generalized to even

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child goes back and forth between two homes and one home is

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chaotic and dysfunctional and crazy and

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unsafe. And you know, there's all kinds of stuff going on at one house.

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One of the concerns is, but

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the child is still gonna have to go back to that environment. In

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this case, the child's still going to have NF1.

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So our response to that,

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how is play therapy going to help when that's not going to go away?

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It's

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coping skills, resilience,

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problem solving

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self trust, competence, confidence,

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belief in self ability to handle things.

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All of that

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means that the child can go into that situation, into that environment,

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face the condition

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and they know that they can handle anything.

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It goes from what if? Oh no

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to,

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I can figure it out.

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I can handle it.

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I can manage it.

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I know what to do. I trust myself. I'll be OK.

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So Bailey, thank you so much for the question that was really helpful.

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Every single one of us work with kids

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that have disorders and diagnoses and conditions.

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So

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it's important that we articulate to parents effectively

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how this is actually going to help. And so I'm really glad that you wrote in Bailey.

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I appreciate it. And again, tell Brittany. Hello.

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All right, y'all thank you so much for emailing me.

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I am

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on a mission to get through every single question that has come in.

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So I'm likely going to be dropping a question a day for quite a while.

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I think if I can manage that.

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So I, you know, thank you for your concern for me. So many of you

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ask if I sleep

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and how I do it all and do I take care of myself and all of those types of concerning?

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You know, you're worried about my self care.

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Thank you for caring about me enough to inquire about that.

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I promise you that I'm good about self care. So

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I want you to know I do sleep at least eight hours every night. I'm good at sleeping.

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I take care of myself. I make sure that I am not overwhelmed. So

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when I sit down to do podcasts and when I coach

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and when we do the collective and all of that,

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that is such a joy to me.

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And I know that a lot of you feel like, oh my gosh, I don't know how you manage it all.

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I manage it all because that fills me up.

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And so I promise you even if I do a question a day for a while,

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I will manage my self care and I promise I will be fine.

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So I just wanted to alleviate your concern.

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You don't need to email me and say, is that really good idea Brenna?

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Because I think you maybe need to just go take a nap.

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I promise I'm well rested and I'm gonna be ok.

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All right. I love y'all. I hope you have a great week. 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.