187 | When Therapy is Cut Short: Understanding the Impact on Stages and Phases

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You're listening to the Play Therapy Podcast with Dr

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Brenna Hicks. 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 of 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 Terri in Ireland

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and her question is about two specific clients,

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but more specifically about not seeing specific stages and phases in a truncated

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therapeutic process. In other words, not able to see them

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till they naturally terminate. But because of being a student,

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she was only given a certain number of sessions with each child.

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And so she's wondering what that means for the stages and phases

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and she shared some specific details about two clients that I can process.

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So let me read a little bit of the

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email and then we'll talk about some thoughts together.

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Ok. So she mentions two clients

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and they are 8 and 10

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and mentions that there's been

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pretty consistent play for the 1st 14 sessions

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and then around the 14 session mark, there was a huge turn in their play.

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And so some questions regarding what stage and phase

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if somehow those were missed because they weren't evident

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and just some different things that she wanted to process.

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So I'll read a little bit from the email.

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So

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the client

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was playing very consistently with the baby for 13 sessions

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and then changed the play quite a bit.

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At the end, it transitioned to robbers and guns and arrests and things like that.

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Other client

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was

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toward the end, well toward the 13th session or so,

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just stopped playing and started talking.

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And so questions are,

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are they still in a stage where they are playing through their process?

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Both appear to be in regressive stage in terms of type of play,

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but I have not seen any aggression

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and are they being cut short because of my training circumstances?

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And then question number two, have I missed subtle signs

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and this changes them coming out of the main work stage

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and moving into mastery? But that doesn't really seem right either.

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What I do know for sure is they were both

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predictively predictably playing for over 14 sessions in the way described

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and, and then did an about turn.

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It's important for you to know that I've met with parents and teachers

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both demonstrated positive and negative

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shifts in their externalizing behaviors.

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One was outwardly more angry but showing increased initiative

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and one started going to bed independently

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but still presenting

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elements of anxiety and anger.

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Is your brain frazzled. I shall stop there. No, it's not frazzled, Terri.

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All right.

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So

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here are some thoughts that I think we

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need to consider as we talk through this because

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one of the outcomes,

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I guess maybe unexpected outcomes for me of covering stages

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and phases and timeline is that therapists have really started

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trying to pinpoint and be really specific

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and

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figure out the stage and the phase and where we are and all of that.

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And so I feel like I'm actually really glad that you emailed this Terri because

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I think that this is something we need to do cautiously and carefully.

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So the stages and the phases are guides,

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they are not hard and fast rules

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and they are not the same for every child

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and it's not linear.

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So we will not ever expect a child

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to go

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1 2 3 4 in order with a set amount of time

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and have no variations and just be able to predictably

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understand what's going on. That is not how the child-centered

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process works.

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So while

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children go through four stages and while they go through four phases,

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and while the timeline is a pretty helpful tool

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for us to know what we can anticipate when

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children are not sardines in the same box.

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And therefore, we cannot expect them to move and progress through therapy

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in that precise fashion.

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So I think I would encourage you all and I said this about themes a while back.

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Don't let

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themes consume you

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and don't spend all of your time and energy trying

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to figure out exactly what the is going on.

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And is this this theme? And if they do this, does that mean this theme?

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Themes are tools and guidelines?

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So just in the same way,

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the stages and phases are not meant to be so

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prescriptive that kind of goes against the child-centered way.

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So here are some thoughts based on what you're sharing, Terri.

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And I think all of us will find this helpful.

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Ok,

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so we know

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when we do not get to complete a full course of treatment with the child

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that they will process the things that they need to. But in

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a shorter fashion, in other words, they don't only get halfway through their stuff,

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they get through all of their things to a lesser degree.

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And so we can anticipate when you're only able to see them for 17 or 18 sessions,

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which that puts them right about at the halfway mark as far as the national average.

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If they're only getting about half of the sessions that most kids need,

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then everything about their play will be different because they're

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trying to process everything in a shorter window of time.

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Whereas they might actually need to work on aggressive play for 12 weeks,

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but they don't have 12 weeks if they're only there for 18.

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So they may shorten that too. They only work on aggression for six or seven weeks

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because they know there are other things they need to address.

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So that naturally modifies

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the traditional sta stages and phases

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because they know that they don't have as long as they would normally

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want to

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with a shortened treatment

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course.

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All right. So another thing to keep in mind

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when kids are going through the stages and phases,

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they will sometimes skip one

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initially. You don't skip it ultimately, but you can skip it initially

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or you can go through a stage or a phase way too fast.

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The kids that are gung ho dive in, they're just like, yeah, let's do this

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and then they quickly realize whoa OK. This was too much, too fast. Too far.

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I need to back pedal here.

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We will see that if kids skip a stage or a phase,

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they will naturally backtrack back to it.

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And sometimes kids will barely visit a stage or a phase.

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So we see it but it's like a blink and then they move on to something else.

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But then eventually they come back to revisit

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those things.

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So I'm trying to paint the picture that just like therapy.

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We use the X and Y axis and we say we always are going up and right,

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but it's not a straight line.

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It's a roller coaster with loops and turns and, and twists. Similarly,

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we are working through these four stages and four phases, but it's not always 1 2 3 4.

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So what we're looking to see

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is that there's going to be

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changes, there's going to be a working of all four of each,

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but not necessarily in that 1 2 3 4 order because sometimes kids come in and week one,

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they're like,

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ok, let's do this.

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And if they're older, they start telling you all of their problems,

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but you are essentially a stranger to them.

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So they did not get the warm up, they did not get the initiation. Guess what?

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That bites them in the butt because they divulge their whole life story to you.

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And then they realize yikes, I don't even know this person.

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I can't believe that I told them all that

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and they withdraw.

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It was too much, too fast, it was too personal, it was too hard, it was too deep.

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Ok? So they completely skipped

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warm up and initiation. They completely skipped resistance.

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They were all in, let's just start dealing with this.

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And eventually, and inevitably

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they backpedal and backtrack and they still need to build a relationship with you.

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They still need to bond and build rapport and build trust.

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So what often happens is, it's a 3 1 3 2 3 4

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kind of deal.

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Ok.

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So we need to be mindful that we're never looking at these,

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that they have to be in order.

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Often they do

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often we can say, OK, we're definitely in initiation,

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we're definitely in resistance and now we've made it

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into work and then when we complete the process,

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we move into termination,

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many kids do follow that format but many kids don't.

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So there can't be an expectation

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that it's always going to be in that order because

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kids work at their pace their way their time.

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All right.

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And then here's another thought, Terri, you're describing that

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the baby doll had always been part of nurturing and caregiving.

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And then all of a sudden the baby was left alone

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and then there was jail and robbing and guns and arresting

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those kinds of things

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that is a shift in storyline.

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So what we're actually looking at there is that thematically,

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we are using

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a new way

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to process something with the same character.

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So you can see that the baby carries over.

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So we've been using baby for nurturing and caregiving.

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Well, baby carries over.

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But now thematically we've shifted even though there's continuity in the play.

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And similarly, when you said the other client started talking,

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ok,

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that is also noteworthy because what a

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child says there's always significance there.

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Now,

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your concern was that you wondered if mom told

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her to because it didn't feel right and yes,

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that happens.

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So

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sometimes a child comes in and says,

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so I wanna talk to you about my anxiety and you're like, hm,

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I wonder who said that to you.

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So sometimes, but again, it's still relevant and significant, right?

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Because a child brings it up because they feel they have to

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that's also significant and relevant.

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But sometimes kids will spontaneously and organically say things

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and we have to pay attention to what they're saying because it matters to them.

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I had a little boy yesterday,

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he brought his hoverboard and he's literally spinning

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in circles on his hoverboard in my playroom.

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And as he's spinning in circles, he says,

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yeah, we were gonna go on a dolphin boat and

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my mom said that I needed to take medicine,

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which what he meant was like anti-nausea medicine.

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Like if you get seasick.

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So he's like my mom said that I need to take medicine and

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we got there and my dad didn't know how many to give me.

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And then I dropped one.

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And so I didn't even take the number that I was supposed to and he was like,

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whatever you've had enough.

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And he's telling me this story

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now,

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could it have seemed like he was just wanting to connect with me or

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wanting to fill me in on what's going on outside of his life?

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Sometimes when kids tell you stories, that's the point in

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this case, he was telling it to me because he never feels safe with his dad.

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His dad is not careful, his dad is not cautious.

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His dad is not thoughtful about the decisions that he makes. So

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my little boy really wanted to know that he wasn't going to get sick on the boat,

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but dad wasn't diligent enough to make sure that he had the right amount of medicine

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and that the dose was correct and that he was going to be ok.

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It was highly anxiety inducing for him.

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That's why he brought it up.

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So when a child starts talking about something,

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whether they feel compelled to or whether it just naturally emerges,

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there's significance there,

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here's why I'm bringing those stories up

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because any change

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in the therapeutic process. So

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anything that changes, they use the same toy in a new way,

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the power and control shifts to a different type of power and control.

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We still see power and control,

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but it's more balanced power now versus dictatorial power.

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They start talking to us about something.

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They bring something from home.

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There's all of these things that take place

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in the process and they're all noteworthy.

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So if we see any kind of resolution of something they've been working on,

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the theme disappears

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or the theme evolves into something else,

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any kind of resolution is noteworthy.

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If there's a shift within a theme, like I just mentioned, that's also important.

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If they take a break from what they've been playing,

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they've played the same thing nine weeks in a row

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and they come in and they don't play it.

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That's significant.

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Or maybe they introduce a new theme completely.

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That's significant. So here's why I'm bringing all that up,

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Terri, I think this is helpful for you.

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It's less important to be able to accurately

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identify what stage and phase the child's in

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and more important to be able to recognize any shifts or changes or

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anything that is different

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in play.

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And those things that I just mentioned are some examples

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actually. And I

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couldn't have planned this if I wanted to. But, you know, divine intervention.

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This is how my life goes.

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Yesterday. I've been playing with a little girl for

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my gosh, probably 3.5 years

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and she is biweekly and there's a really long story as to why I'm still seeing her,

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but she's actually quite stable,

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but there's just a lot of stuff going on with custody and et cetera, et cetera.

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So

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I'm involved in that

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process as well from the legal side.

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So there's been a lot longer of a process with her,

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but I'm bringing this up because yesterday

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is the first time that she has shifted her play

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in more than a year

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every single week. It's exactly the same thing.

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She's an animal that I find

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usually in the woods or a cave.

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But there's always this surprise discovery of a

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baby animal that has been left by its parents

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and I am the new owner and I take it to the vet

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and I have to play the role of the owner and the vet.

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So I have to switch roles depending on if we're at home or if we're at the vet's office

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and I have to take care of the animal at the vet's office and I

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have to take care of the animal at home and there's always a baby animal.

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So it varies from a dog, a cat, a bunny, a fox, whatever.

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Ok. That has been more than a year of that

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theme

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yesterday. She starts with that. She says, what animal am I going to be today?

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And then she grabs the swords

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and turns the story completely

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into

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nothing I've ever seen before.

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She gives me swords, she has swords, she's sword fighting with me.

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She has special powers that no one can find out about.

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She doesn't tell outsiders why she's immortal.

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She has these secret friends that she practices sword fighting with,

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but I stumble upon them and then she has to fight me and she

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threatens to kill me because she thinks I'm going to tell her secrets.

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And

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I, I was like literally shocked in session

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because for a year, she has played the same nurturing caregiving

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type of play.

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And now all of a sudden huge shift to power and control.

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Notice there are some similar thematic elements

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worked in

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but notice the huge shift and there's aggression

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and there's power and control. Ok. That's noteworthy.

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My brain never once went to, oh, what stage and phase does this indicate

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it went to? Wow, this is such a huge shift.

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I'm so happy to see that she's doing something that she needs to do in here.

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So I hope that that's helpful for you all.

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Please don't get caught up in identifying the stage and the phase as a priority.

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It's relevant. Yes, it's helpful. Yes, but

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it doesn't always work in that chronological fashion

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and that should not be the focus.

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The focus should be more on what's happening and

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why the shifts or changes are taking place.

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All right.

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So thank you so much, Terri for the email, by the way, as I mentioned earlier,

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but you still have a couple of months.

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So some of you like to put things off. I'm aware,

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I'm going to be in Atlanta for the play therapy conference in October.

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So please please please make plans to be there. I would love to have you all there.

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I know many of you said you're going,

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we're going to have a huge meet up on Friday night.

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So even if you don't stay for the whole conference,

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I would just love to meet you in person

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and there's gonna be a ton of podcasts and collective and coaching people all there.

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So I'd really,

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really love to meet you and really looking forward to that time together.

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So

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check that out. It's in Atlanta, in October

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and you can get hotel rooms and tickets to the conference all in one fell swoop.

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Just go to APTs website and click on the conference link.

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All right. If you want to reach out to me, please do brenna@thekidcounselor.com.

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You can also leave me a voicemail if you have a question

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at 813-812-5525. Love. Y'all have a great week. We'll talk again soon. Bye.

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Thank you for listening to the Play Therapy Podcast with

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Dr brenna hicks for more episodes and resources.

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Please go to www.playtherapypodcast.com.