259 | Early Termination, Rewards, and Night Terrors: Q&A Addressing Unique Playroom Challenges

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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

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actually 3 questions from Melissa in Colorado.

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So,

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Melissa,

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thank you for the email

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and thanks for

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giving us a chance to dive into these together.

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So

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the first is about when we have to terminate

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early with a child

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and the process

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and how the child receives and responds to the early termination.

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The second is about rewards for desired behaviors.

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Yikes,

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I'm shuddering at that conversation,

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but we'll dive in.

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And then children that are experiencing night terrors.

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So,

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uh,

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a

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pretty vast

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variety here of

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conversation topics today,

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but I think all are really helpful,

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so we'll hit each of them together.

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So I'm going to read parts of her email,

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and then we'll dive into each question.

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So the first is a 4 year old that she had been seeing for 6 sessions

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and needed to terminate and refer him

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to a different therapist because of pregnancy.

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And so I won't read all of it,

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but

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I'll hit some highlights for you.

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So

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essentially

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he was pretty closed off at the beginning,

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then he became more engaged.

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He was pretty resistant,

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so every time she would

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use the skills,

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he would say,

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don't say that or stick his tongue out.

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And then there was a lot of inconsistency with the sessions.

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So parents were not bringing him every week.

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So then there was

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a gap there and,

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and some difficulty with making sure that there were weekly sessions.

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So then when he came back,

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he was hesitant,

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but eventually he did.

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And then destroyed the room.

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So,

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oh yes,

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room wrecks,

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they're so fun.

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collateral damage.

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All right.

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So

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he was hitting her,

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hitting her in the face,

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throwing things at her,

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and then he would say,

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does it hurt

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when he would throw things and then when she set a limit,

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he went like,

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for example,

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my face is not for hitting,

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he would say,

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no,

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it is.

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I,

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I,

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I'm,

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I'm digressing for a second,

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but

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I love it when you set a limit and

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the child just basically comes back with the opposite.

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Like you say,

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oh,

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the wall's not for drawing on,

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yes it is.

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I find that so funny.

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It's,

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I'm like,

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you clearly have no abstract reasoning whatsoever.

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Anyway,

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so he's arguing that her face is for hitting

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and so her question is,

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I want to know how to better handle the moments

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when the aggression is directed at you as the therapist.

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This was my first time having a kid with that much aggression.

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And so it was just kind of a surprise and then the final session,

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he was completely closed off and distant

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and used

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a pillow to build bridges and hid under them

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and

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was basically very

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disengaged in the final session.

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So how she could have handled that better is the question.

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All right,

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so we've talked a lot about aggression,

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but general rule

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is

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if the child is actively violating a limit

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before you've even started

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stating the limit.

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In other words,

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they're already hitting you,

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they're already throwing things at you,

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they're already in the midst of whatever it is that the limit would

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be required,

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you jump straight to the neutral limit first.

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So,

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oh,

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I'm not for hitting.

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That's the first thing that you say.

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So instead of going ACT

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you do C ACT.

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So,

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oh,

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my face is not for hitting or I'm not for hitting.

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Then

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go back to.

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You're really wanting to show me how strong you are,

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or you

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want me to know how upset that made you,

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or whatever the feeling is,

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then

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reminder of the limit that's already been set,

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my face is not for hitting,

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and then

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you offer the choices instead.

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So that is your go to.

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Now,

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sometimes things are happening at such rapid fire pace,

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you feel like you can't even get three words out,

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let alone an entire limit.

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So at that point you default directly to neutral limit

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as fast as you can mutter it,

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muster it,

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utter it.

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That was two words combined,

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and

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you then just say,

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I'm not for hitting,

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and you say it with an emphatic,

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pretty direct tone.

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It is not.

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Heavy,

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it's not angry,

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it's not anxious,

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it's not emotional at all.

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But you say it with a firm,

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clear,

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direct voice.

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Oh,

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I'm not for hitting.

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And then you soften

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You're really

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Throwing those hard,

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but

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I'm not for throwing things at

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whatever you gentle

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and soften.

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After you've already said it very directly.

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And then when it's directed at you,

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first of all,

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we talk about this in coaching quite a bit.

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It's not about you,

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even though it feels very personal,

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and when you're on the receiving end of aggression,

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especially physical aggression,

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because verbal aggression

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is pretty awful,

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but in a different way.

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When there's physical aggression aimed directly at us,

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it can feel very personal and it can be very hard

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to tolerate and handle,

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especially neutrally since we're in the neutrality podcast series.

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But

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the goal is

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that you recognize it as a means to an end.

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There's no other person in the playroom to direct any of

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the behavior or the words or the attitudes or whatever at.

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He can't be aggressive to anyone else.

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He can't say mean things to anyone else.

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He can't try to hurt anyone else.

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He can't be disregulated in front of anyone else.

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It's you and only you.

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So it's not personal.

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You have to remember that.

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You have to remain neutral because you have to recognize it

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for what it is and accept it for what it is.

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It's necessary play.

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Kids almost always have to play aggressively,

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almost always,

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and that looks different for different children,

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but there's almost always aggressive play

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in the course of treatment.

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And when it's at us,

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directed at us,

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it is harder,

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but it's the same principles

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if the child was being aggressive toward Bobo.

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We set limits when necessary,

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and otherwise we neutrally accept it for what it is.

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And the fact that,

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you know,

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you only saw him for 6 or 7 sessions and then had to transfer and he had to terminate and

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that made everything much more complicated.

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So I think he was probably angry at you.

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I think he was probably pretty resentful and there was a lot wrapped up in

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that being directed toward you.

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I think more than just traditional play.

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I think that was probably trying to

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have revenge and,

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and help you know how angry he was at you.

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So there are layers to that,

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and that's another thing that we have to face as we

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do this work and if we do it long enough,

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there are going to be times when circumstances mean that

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kids get angry at us

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and

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sometimes they want us to know it

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and it's not fun to be on the receiving end of that anger,

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but again,

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neutral acceptance and limits when necessary.

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OK,

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so let's move on to what are my thoughts on rewards for desired behaviors.

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For example,

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I have parents who have kids who are constantly

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wetting themselves and have a hard time with why.

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I know that in an episode you talked about something similar,

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but I can't seem to find it again.

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If I remember correctly,

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you said that it is a start,

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but it shouldn't be the only thing.

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Let me know if I'm remembering it wrong.

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OK.

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We can't always stop a parent from

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using a reward chart.

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So if they want to work on.

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Making sure the child uses the toilet,

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and they want to do a sticker chart,

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you know,

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and if you get 5 stickers in a row,

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you earn whatever.

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I understand the premise.

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I know that's an educational model that's in schools all the time.

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I,

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I'm treading lightly here because I know that

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there's all kinds of support for that kind of approach.

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Kids

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need immediacy,

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and kids need very clear connection to action and consequence.

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So,

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I don't know if I've ever shared this story before,

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but I think maybe I did,

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I don't know.

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Maybe on the parenting podcast,

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I,

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I forget to whom I say what.

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When our son was potty training,

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he's 15 now,

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so,

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I mean,

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I'm going back quite a ways,

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but

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when

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he was potty training.

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The

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thing that made the most sense to me

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was

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make it fun.

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So when he was learning to pee in the toilet,

286
00:08:56,099 --> 00:08:58,650
he was aiming at Cheerios floating in the water.

287
00:08:59,549 --> 00:09:00,979
That makes it really fun.

288
00:09:01,429 --> 00:09:03,059
And then

289
00:09:03,349 --> 00:09:03,820
his

290
00:09:04,070 --> 00:09:04,650
reward,

291
00:09:04,710 --> 00:09:05,539
if you will,

292
00:09:06,390 --> 00:09:07,229
was when he,

293
00:09:07,270 --> 00:09:08,080
and it was a choice,

294
00:09:08,190 --> 00:09:09,619
let's be very clear,

295
00:09:09,869 --> 00:09:10,739
it was a choice.

296
00:09:12,020 --> 00:09:14,450
If you choose to go to the bathroom and the toilet,

297
00:09:14,700 --> 00:09:15,530
you choose.

298
00:09:16,380 --> 00:09:17,210
Consequence

299
00:09:17,809 --> 00:09:19,960
and for him it was a tic tac.

300
00:09:20,880 --> 00:09:22,909
He loved orange Tic Tacs.

301
00:09:23,280 --> 00:09:23,950
So,

302
00:09:24,359 --> 00:09:24,760
you know what,

303
00:09:24,869 --> 00:09:26,159
if you pee in the toilet,

304
00:09:26,280 --> 00:09:27,510
you've chosen to have a Tic Tac.

305
00:09:27,799 --> 00:09:28,799
If you poop in the toilet,

306
00:09:28,840 --> 00:09:30,640
you've chosen to have two Tic Tacs.

307
00:09:31,739 --> 00:09:34,549
So the moral of the story is there was immediacy there.

308
00:09:34,880 --> 00:09:36,750
As soon as he used the toilet,

309
00:09:36,919 --> 00:09:37,929
he got a tic tac.

310
00:09:38,530 --> 00:09:40,260
This notion of a chart

311
00:09:40,559 --> 00:09:41,530
or a system

312
00:09:41,760 --> 00:09:44,789
or whatever where they have to accrue things,

313
00:09:45,510 --> 00:09:46,590
5 days,

314
00:09:46,799 --> 00:09:47,619
3 days,

315
00:09:47,719 --> 00:09:49,909
4 hours is an eternity

316
00:09:50,200 --> 00:09:50,869
to a child.

317
00:09:51,679 --> 00:09:52,710
And this whole notion,

318
00:09:52,750 --> 00:09:54,119
if you get 5 stickers in a row,

319
00:09:54,190 --> 00:09:57,340
then you're gonna get to go to the ice cream shop at the end of the week.

320
00:09:57,630 --> 00:09:59,140
That is not incentivizing,

321
00:09:59,229 --> 00:10:00,659
that is not motivating.

322
00:10:00,909 --> 00:10:04,700
It does not address the child's currency or their need for immediacy

323
00:10:04,909 --> 00:10:06,820
and their lack of awareness of time.

324
00:10:08,119 --> 00:10:10,619
So I think the only way that something like that

325
00:10:10,619 --> 00:10:13,419
works is that if it is framed in a choice.

326
00:10:14,369 --> 00:10:16,989
And if it is immediate in nature.

327
00:10:17,400 --> 00:10:17,789
So,

328
00:10:18,039 --> 00:10:19,239
you chose to pee in the toilet,

329
00:10:19,320 --> 00:10:20,599
you choose to get a tic-tac.

330
00:10:21,729 --> 00:10:23,650
That is how this works.

331
00:10:23,969 --> 00:10:25,940
I think anything beyond that,

332
00:10:26,130 --> 00:10:29,520
it's just something that adults do that they think will work,

333
00:10:29,609 --> 00:10:30,960
but it doesn't actually work.

334
00:10:31,780 --> 00:10:32,979
So that's my thought on

335
00:10:33,140 --> 00:10:33,960
rewards.

336
00:10:34,099 --> 00:10:34,260
And,

337
00:10:34,299 --> 00:10:35,260
and generally speaking,

338
00:10:35,340 --> 00:10:36,570
let me just be really clear.

339
00:10:39,049 --> 00:10:39,780
Oh,

340
00:10:39,929 --> 00:10:41,359
how do I say this diplomatically?

341
00:10:42,359 --> 00:10:45,650
Rewards fly in the face of the child-centered model.

342
00:10:46,950 --> 00:10:49,460
Because that means there's external motivation,

343
00:10:49,789 --> 00:10:51,979
there's extrinsic locus of control.

344
00:10:52,890 --> 00:10:58,390
And the child learns that if I please someone or do what someone wants me to do,

345
00:10:58,679 --> 00:11:01,190
then I get value and acknowledged.

346
00:11:03,109 --> 00:11:05,719
That is not adherent to CCPT.

347
00:11:06,200 --> 00:11:06,570
So,

348
00:11:06,599 --> 00:11:08,380
just generally speaking,

349
00:11:08,799 --> 00:11:09,950
let's avoid

350
00:11:10,559 --> 00:11:11,440
rewards.

351
00:11:11,559 --> 00:11:14,679
Let's avoid parents using rewards.

352
00:11:14,840 --> 00:11:17,010
Let's help teachers understand why

353
00:11:17,200 --> 00:11:20,349
a reward-based system is not effective with children.

354
00:11:21,609 --> 00:11:23,159
We want kids to

355
00:11:23,500 --> 00:11:24,119
choose

356
00:11:24,299 --> 00:11:25,250
to do the right thing.

357
00:11:25,460 --> 00:11:27,609
We want kids to choose to obey.

358
00:11:27,820 --> 00:11:30,479
We want kids to choose to self-control,

359
00:11:31,500 --> 00:11:33,489
that is internally motivated,

360
00:11:34,099 --> 00:11:35,849
intrinsic locus of control

361
00:11:35,979 --> 00:11:37,979
that doesn't happen from rewards.

362
00:11:39,229 --> 00:11:39,950
Treasure box,

363
00:11:40,000 --> 00:11:40,929
prize box,

364
00:11:41,070 --> 00:11:43,909
sticker charts. that's,

365
00:11:43,989 --> 00:11:44,559
it's just,

366
00:11:44,630 --> 00:11:46,380
it does not make sense

367
00:11:46,590 --> 00:11:47,130
with

368
00:11:47,479 --> 00:11:48,659
kids that aren't rational

369
00:11:48,989 --> 00:11:50,580
and kids that have no sense of time.

370
00:11:51,719 --> 00:11:52,479
So that's my

371
00:11:52,590 --> 00:11:54,349
diplomatic approach to the rewards.

372
00:11:54,929 --> 00:11:55,320
OK,

373
00:11:55,479 --> 00:11:56,679
I don't think I was very diplomatic,

374
00:11:56,690 --> 00:11:57,349
but I tried.

375
00:11:57,719 --> 00:11:57,919
All right,

376
00:11:58,119 --> 00:11:58,400
finally,

377
00:11:58,520 --> 00:11:59,359
night terrors.

378
00:11:59,640 --> 00:12:00,150
I've

379
00:12:00,320 --> 00:12:02,159
had a lot of parents reporting that their kids

380
00:12:02,159 --> 00:12:04,229
are having night terrors and they aren't sure why.

381
00:12:04,520 --> 00:12:06,400
Some parents say that night terrors occur when

382
00:12:06,400 --> 00:12:09,070
the child is overstimulated after a long day.

383
00:12:09,270 --> 00:12:11,109
I'm wondering if you have any insights on this.

384
00:12:11,640 --> 00:12:11,799
All right,

385
00:12:11,919 --> 00:12:15,390
it is actually very normal in childhood for children to have night terrors.

386
00:12:16,580 --> 00:12:19,489
That's a pretty consistent part of development.

387
00:12:19,700 --> 00:12:22,270
So I think we have to normalize first and foremost,

388
00:12:22,619 --> 00:12:27,340
and I absolutely agree with you when the child is emotionally overwhelmed.

389
00:12:28,799 --> 00:12:29,460
Usually

390
00:12:29,760 --> 00:12:30,909
related to therapy.

391
00:12:31,239 --> 00:12:32,650
So when kids get into therapy,

392
00:12:32,919 --> 00:12:34,690
sometimes night terrors spike

393
00:12:35,440 --> 00:12:36,070
because

394
00:12:36,359 --> 00:12:38,190
it's bringing up a lot of stuff.

395
00:12:38,479 --> 00:12:41,030
When kids have had a very exhausting day,

396
00:12:41,280 --> 00:12:42,719
when they've been overstimulated,

397
00:12:42,840 --> 00:12:45,590
when their nervous systems are frazzled.

398
00:12:46,520 --> 00:12:49,080
There's often comorbidity with night terrors.

399
00:12:50,219 --> 00:12:51,099
So first,

400
00:12:51,159 --> 00:12:53,789
I think parents need to be reassured that they're normal and

401
00:12:53,789 --> 00:12:56,250
it's not something they need to be especially concerned about.

402
00:12:57,059 --> 00:13:00,169
It's also helpful to make them aware that

403
00:13:00,460 --> 00:13:00,929
it's

404
00:13:01,059 --> 00:13:03,049
connected to somatic

405
00:13:03,419 --> 00:13:03,849
stuff

406
00:13:04,020 --> 00:13:05,489
and emotional stuff.

407
00:13:06,179 --> 00:13:07,979
So when kids are stressed,

408
00:13:08,099 --> 00:13:08,900
when they're anxious,

409
00:13:08,979 --> 00:13:10,020
when they're overwhelmed,

410
00:13:10,260 --> 00:13:12,729
when therapy brings up a whole bunch of stuff,

411
00:13:13,539 --> 00:13:17,440
we usually see an uptick in reactions like that.

412
00:13:18,400 --> 00:13:22,440
So that's just a pretty standard part of the process and helping parents understand

413
00:13:22,799 --> 00:13:25,109
that they shouldn't be overly concerned about it

414
00:13:25,359 --> 00:13:27,960
is usually pretty reassuring as far as how

415
00:13:27,960 --> 00:13:30,200
to help parents deal with the night terrors,

416
00:13:30,390 --> 00:13:33,500
most often kids are not fully awake during a night terror,

417
00:13:33,840 --> 00:13:34,979
so trying to talk to them,

418
00:13:35,039 --> 00:13:35,880
communicate with them,

419
00:13:36,000 --> 00:13:36,679
interact with them,

420
00:13:36,690 --> 00:13:38,309
it usually does not work.

421
00:13:38,929 --> 00:13:42,630
They actually are asleep even though they do not present as asleep,

422
00:13:42,919 --> 00:13:44,830
and often they're quite irritable

423
00:13:45,119 --> 00:13:45,859
in a night terror.

424
00:13:46,200 --> 00:13:48,239
So if you try to talk to them or try to soothe them,

425
00:13:48,280 --> 00:13:50,229
it often angers them more.

426
00:13:51,000 --> 00:13:51,409
So,

427
00:13:51,479 --> 00:13:52,349
the most

428
00:13:52,630 --> 00:13:56,750
helpful thing that we have found at the center and even just personally,

429
00:13:57,320 --> 00:13:59,109
is that you just

430
00:13:59,520 --> 00:14:00,030
say,

431
00:14:00,359 --> 00:14:00,880
it's OK,

432
00:14:00,919 --> 00:14:02,010
it's time to go to bed.

433
00:14:02,869 --> 00:14:03,460
It's OK.

434
00:14:03,580 --> 00:14:04,619
Let's get back in bed.

435
00:14:05,309 --> 00:14:05,859
It's OK,

436
00:14:05,940 --> 00:14:06,849
let's go to sleep.

437
00:14:07,840 --> 00:14:08,200
Very,

438
00:14:08,320 --> 00:14:09,080
very short,

439
00:14:09,280 --> 00:14:09,710
soft,

440
00:14:09,840 --> 00:14:10,580
gentle,

441
00:14:10,840 --> 00:14:12,549
quick phrases

442
00:14:12,919 --> 00:14:15,030
and help the child lay back down

443
00:14:15,239 --> 00:14:17,789
and usually that allows them to

444
00:14:18,159 --> 00:14:20,520
get back into a calm state of sleep since they were

445
00:14:20,520 --> 00:14:22,979
in a very aroused state of sleep in a night terror.

446
00:14:23,979 --> 00:14:24,229
All right,

447
00:14:24,419 --> 00:14:24,500
so,

448
00:14:24,510 --> 00:14:24,909
Melissa,

449
00:14:25,039 --> 00:14:26,380
I hope that that's helpful for you.

450
00:14:26,460 --> 00:14:29,140
I hope that's helpful for each of you as you

451
00:14:29,140 --> 00:14:31,530
listen and as you work with kids and their families.

452
00:14:32,440 --> 00:14:33,229
I love you all.

453
00:14:33,349 --> 00:14:34,159
If you want to reach out,

454
00:14:34,229 --> 00:14:37,380
please do brenna@thekidcounselor.com and oh,

455
00:14:37,469 --> 00:14:37,669
OK,

456
00:14:37,710 --> 00:14:38,309
I forgot,

457
00:14:38,349 --> 00:14:38,739
almost.

458
00:14:39,250 --> 00:14:40,700
I remembered at the last second.

459
00:14:41,070 --> 00:14:43,190
There is an official meet up in

460
00:14:43,510 --> 00:14:45,000
Mississippi planned now.

461
00:14:45,669 --> 00:14:46,340
So please,

462
00:14:46,349 --> 00:14:48,429
if you are going to attend the conference

463
00:14:48,429 --> 00:14:51,030
or if you're within driving distance of Oxford,

464
00:14:51,070 --> 00:14:51,659
Mississippi,

465
00:14:52,070 --> 00:14:54,460
please sign up for the meetup

466
00:14:54,710 --> 00:14:56,229
and details to follow,

467
00:14:56,390 --> 00:14:58,030
but it will be that Friday,

468
00:14:58,070 --> 00:14:58,859
the 20th.

469
00:14:59,530 --> 00:15:02,330
And we will have a meet up in the square,

470
00:15:02,500 --> 00:15:04,739
which is kind of the downtown area of Oxford,

471
00:15:04,820 --> 00:15:06,390
a very historic area.

472
00:15:06,900 --> 00:15:07,820
Really looking forward to that.

473
00:15:07,859 --> 00:15:10,179
I've already chatted with several people that are coming to

474
00:15:10,179 --> 00:15:11,989
the conference and I can't wait to meet you all.

475
00:15:12,059 --> 00:15:12,299
So

476
00:15:12,820 --> 00:15:14,380
if you can make it to Oxford,

477
00:15:14,419 --> 00:15:15,020
Mississippi,

478
00:15:15,340 --> 00:15:16,750
just south of Tennessee,

479
00:15:17,260 --> 00:15:21,059
then it would be so much fun to have a lot of people turn up at the meetup.

480
00:15:21,099 --> 00:15:24,849
So make sure that you go to the show notes so that you can RSVP to the event.

481
00:15:25,179 --> 00:15:25,380
All right,

482
00:15:25,539 --> 00:15:25,880
love you all.

483
00:15:25,940 --> 00:15:26,659
We'll talk again soon.

484
00:15:26,859 --> 00:15:27,020
Bye.

485
00:15:28,219 --> 00:15:30,979
Thank you for listening to the Play Therapy Podcast with Dr.

486
00:15:31,140 --> 00:15:32,059
Brenna Hicks.

487
00:15:32,219 --> 00:15:34,179
For more episodes and resources,

488
00:15:34,340 --> 00:15:39,059
please go to www.playtherapypodcast.com.