270 | When a Child Falls Asleep in Play Therapy: Trusting the CCPT Process

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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

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question from Chris,

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and Chris reached out earlier.

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He's in the Virgin Islands and he has reached out with another scenario.

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So this one is about an older child,

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14 year old client,

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and a client who tends to fall asleep in session.

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So I'm really excited to answer this.

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It's interesting.

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Everything in my life goes in cycles,

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as I've mentioned before,

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and in the coaching groups lately,

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we've talked about several

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cases where kids fall asleep in session and how to handle it,

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what to do about it.

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So,

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Chris,

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thanks for the email,

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thanks for reaching out about this.

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So I'm gonna read parts of his

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question and then we'll dive in together.

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I'm working with a 14 year old boy.

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He has no siblings and no relationship with his father.

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I've known him from groups and he was referred for individual therapy.

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I hold

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CCPT

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values.

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However,

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this boy's authentic,

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self-directed way of being involves him falling asleep during the session.

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He has been diagnosed with autism,

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which I'm skeptical about,

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and I've not checked the testing report.

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He does fit some of the criteria,

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but I'm still skeptical,

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and I don't like diagnoses,

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nor do I.

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I reflected his anxiety,

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his uncertainty,

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ambivalence,

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and empathized with him.

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His mother is relatively impatient for the process

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and seemingly doubts it as he reports he does nothing during the session.

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Also,

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there's the dimension of insurance reimbursement if he does sleep.

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Either way,

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my question is,

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what is the CCPT way to work through this presenting issue?

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He has not been verbal with me

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but presents as aware and cognizant.

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OK.

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So let's,

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there's lots of layers here.

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So let's try to dive into these one at a time.

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First and foremost,

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CCPT is predicated on relationship.

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So Chris,

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uh,

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you didn't mention how many sessions you'd had with him,

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but number one,

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first and foremost,

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every bit of any

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scenario.

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So regardless of the presenting concern,

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regardless of the frustration,

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regardless of the lack of awareness of how to handle something,

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our number one priority

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is to establish relationship,

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trust,

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rapport,

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all of those things.

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My gut tells me you've already done that,

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and that's why he's comfortable enough to come in and sleep.

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So my second thought is

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CCPT is also predicated on

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children know what they need.

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And children will get their needs met

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if they're given the time,

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the tools and the opportunity.

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They'll work through their stuff,

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they will address what they need to,

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and it will be because it's a means to an end necessary part of their healing journey.

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So in the coaching groups when we've talked

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through scenarios where a child falls asleep.

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In one in particular,

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she fell asleep consistently every week,

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similar to what you're describing,

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Chris.

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So

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here is what we discussed and here's what I think

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is really helpful for us to keep in mind.

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If a child comes in

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and has an hour to do whatever he chooses.

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Let's think about this from a developmental perspective first.

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He's 14.

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He has hormonal changes,

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chemical changes,

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physical changes,

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social changes,

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academic changes,

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mental changes,

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psychological changes.

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Being a 14 year old is hard.

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It's exhausting

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and it's taxing and it takes a toll.

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So even if this is not

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a fatigue issue,

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meaning he actually is in fact getting enough sleep,

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I don't know.

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Maybe he's staying up playing video games all night

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and so he is not getting enough sleep.

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That's something you would process with mom in a parent consultation.

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But

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even if he is not overly fatigued.

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He is likely just tapped out

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because of everything that he's going through out of 14.

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So,

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I would argue that

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if we believe that we can trust kids,

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When a kid comes in and they have an hour to do whatever they choose,

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and they just need

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the peace,

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the calm,

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the comfort,

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the safety,

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the assurance

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that

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it's OK for me to just rest.

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I think that's a gift for kids and that's what we've talked about in the coaching.

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In this particular case that I'm speaking about,

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she was selectively mute.

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And she would come in and fall asleep.

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And we talked about,

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think about how high

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her anxiety levels are,

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if she's struggling with selective mutism.

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And if she can have a reduction in anxiety for that hour where she feels safe enough

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and

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less anxious enough to sleep,

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what a gift that is to her.

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And keep in mind too,

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with teenagers,

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if they don't want to come,

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if they hate you,

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if they hate therapy,

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if they hate CCPT,

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if they hate any of it,

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they'll let you know.

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So Chris,

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the fact that he's coming in

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willingly each week,

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he's choosing not to talk,

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could be tied to very high levels of anxiety,

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similar to the girl that I was just speaking about with my coaching participant.

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So

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are his anxiety levels

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through the roof high?

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And he never gets rest,

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he never gets peace.

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Nothing's ever quiet and calm and stable enough

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for him to feel at ease.

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Maybe your room

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and that time with you is the only time that

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he can allow himself to relax enough to sleep.

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We have no idea the deeper things that are going

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on often when kids come in and play with us.

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So if he comes in and falls asleep,

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and we truly believe in CCPT and we truly trust the process.

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This is something where

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he's meeting his needs.

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And

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he will self-actualize as a result of it.

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Let's think about Maslow for a second,

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and I know I'm,

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I'm digressing a smidge,

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but this is relevant,

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I promise.

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Think about the hierarchy of needs.

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If you don't know that you're going to have food,

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water,

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and shelter,

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you're not going to worry about becoming the best version of yourself.

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If he is this anxious,

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this exhausted,

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this tired,

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this worn out.

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He's not gonna be able to do work.

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So

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there are precursors sometimes.

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Now the caveat is sometimes kids will come in and to.

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Be avoidant,

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to resist,

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to power struggle,

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to have control over things,

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they will pretend to sleep.

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In other words,

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that's their little watch this.

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I'm not gonna do anything with you today.

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I'm just gonna pretend like I'm sleeping.

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That could warrant a limit.

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Because you know that

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that is

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for a different agenda.

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If this child is coming in that exhausted and actually falling asleep,

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I would argue that's what the child needs most.

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So then to speak to your question about

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Mom is impatient,

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and

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he reports that he does nothing in session.

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Well,

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many times kids will say that they didn't do anything in session,

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or they'll say,

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we just played.

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And parents receive that as,

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what's the point?

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This isn't helping.

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There's nothing productive or therapeutic about playing or doing nothing.

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That's a conversation that needs to be had with mom.

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You have to help her understand the process,

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you have to help her understand expectations.

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You have to help her understand how valuable it is

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that he comes in and he gets to be in charge.

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And if he chooses to do nothing,

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there's still meaning there.

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You also have to help her understand that you don't have to talk

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for this to be therapeutic.

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He doesn't have to play for this to be therapeutic.

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That's a lot of psycho education for mom in a consult.

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And then finally your question,

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there's the dimension of insurance reimbursement if he does sleep.

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We are exclusively private pay at my center,

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so

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I cannot speak to insurance reimbursement,

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but here is what

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I know.

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There have been a few times that I've had a child fall asleep in session,

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and it has not been

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a weekly scenario.

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This child,

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it sounds like is coming in and falling asleep every week.

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My other coaching participant,

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she was coming in and falling asleep every week.

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That's a little bit of a different dynamic.

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The only times that I've had kids fall asleep

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is when they were sick or getting sick

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or up all night in the hospital in one case.

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So in those scenarios,

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I chose not to charge.

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I explained to parents,

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I did not say the child fell asleep.

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I just said.

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There was just,

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there wasn't a whole lot that happened in this session.

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She's just exhausted.

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She didn't really have any energy to do anything

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and I don't feel comfortable charging you for it.

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I don't feel like it was therapeutically productive,

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so I'm gonna not bill you today.

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That was my discretion,

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my choice,

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and that's a customer service standpoint.

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For insurance,

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I would argue

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that you could

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justify that that's what the child needed

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and it was therapeutically valuable because this too shall pass.

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One of my favorite quotes is,

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put the power of this too shall pass at work in your perspective.

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He's not going to sleep in every session forever.

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The coaching participant that I mentioned,

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her,

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her girl stopped sleeping

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eventually.

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This too shall pass.

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I think this is means to an end.

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I think this is knowing what the body needs and what the mind needs,

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and I think he just needs to have some rest and some downtime.

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I don't think it will happen long term.

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So I think you actually could justify

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that that is necessary and therapeutically valuable,

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but again,

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I'm speaking outside of my scope because we do not bill insurance.

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But Chris,

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I think my,

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my big takeaway for this question.

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I

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you are

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providing an environment,

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you're providing a relationship.

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And he knows what he needs and he'll do the work.

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So

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I would be patient,

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I would trust it.

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I would know that

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he is working on things that he needs to work on.

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And every

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scenario might be a little bit different.

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That's why we need to use our clinical judgment.

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Like I said,

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if you can tell that it's resistance or avoidance or power and control or whatever,

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you know,

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you can say,

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oh,

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you're pretending to sleep,

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but you know that our playtime isn't for sleeping.

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That would be an appropriate limit to set if it's that kind of scenario.

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A kid that just really needs to sleep

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and never gets an opportunity to except that hour with you.

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What I shared in that coaching call is what a gift.

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Chris,

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what a gift to this little boy.

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That

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he gets to come in and finally have

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a relaxed hour

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where he's at peace and calm

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and internally settled enough

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that he can get the rest that he needs.

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My take,

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if you have a difference of opinion,

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I would love to hear from you.

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Email me and tell me that you think I'm crazy.

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I'm,

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I'm happy to have a

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lively debate.

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All right,

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Chris,

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thank you so much for the question.

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Y'all,

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I love you.

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Hope you have a great week.

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We'll talk again soon.

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Bye.

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Thank you for listening to the Play Therapy Podcast with Dr.

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Brenna Hicks.

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For more episodes and resources,

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please go to www.playtherapypodcast.com.