Brenna Hicks, PhD, LMHC

Active Play In Kids

Brenna Hicks — Tue, 12 Sep 2017 15:33:28 +0000

Active Play In Kids

The more we understand about the impact that play has on our brains, the better we value the sometimes crazy, chaotic, aggressive, or active play that kids like. Interestingly, the more kids engage in active play, the more self-regulation they achieve!

Kids are given opportunities to play less and less. Schools have reduced or eliminated recess for elementary school kids. Many kids go to before and after school care, where they do homework or play video games. Then they come home, go to extra-curricular activities, eat dinner, shower, and go to bed. They have been deprived of almost all of their spontaneous and imaginative play time!

Parent Involvement

To further complicate the play reduction, many times when kids are allowed to play, parents interfere, correct, intervene, or alter the natural process of children playing. The beauty of play is that there are natural and built-in checks and balances. Bossy kids are left out. Aggressive kids are shunned. Quiet kids are forgotten. Smart kids are ridiculed just like everyone else. This process is a natural groomer of appropriate behavior.

Research

Recent research shows that more than other types of play, the aggressive and active play is extremely beneficial for brain growth. This is because in several regions of the brain, rough and tumble play results in a massive release of GABA (gamma-Aminobutyric acid). GABA is a neurotransmitter that is chiefly responsible for the reduction of neural excitability.

So, yes, you read that correctly – when kids are aggressive, rough, and active in behavior, they are activating growth in the brain and releasing a neurotransmitter that encourages self-regulation. So, the more often kids play wrestle, pillow fight, tackle, push, or shove, the better their brain becomes at emotional and mental control.

Play Therapy

And that is why play therapy is so significant! Kids are given freedom and liberty in the play room that they are not given anywhere else. They can pummel the Bobo, stomp on the baby doll, kill their enemy, stab the bad guy, and bury their friends in the sand without fear of reaction, consequence, or repercussion. And as they play out those scenarios, they are helping themselves stay in control in other areas of their lives.

Play therapy always provides a safe place to practice learning new skills that they require to thrive in everyday situations. And the process of playing is a natural and instinctual need for kids, because they inherently know that they can figure out themselves and the world around them using toys as their words and play as their language.

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Universality of Play Therapy

Brenna Hicks — Thu, 17 Aug 2017 18:03:02 +0000

I recently started working with a little boy who speaks Spanish exclusively in his home. When his mother called me to inquire about my services, she asked if I speak Spanish. When I questioned further about why she wanted to know, she informed me that he will probably say words in Spanish to me in the session. While I actually do speak Spanish, I told her that play therapy transcends language and culture and what is spoken is far less important than what is done.

Culture

Many studies have been conducted on the effectiveness of play therapy in any culture. Families with very diverse backgrounds, including different types of communication styles and level of comfort with conversation, have all proven play therapy to be helpful. Further, it has allowed for therapists trained in play therapy to effectively treat families from diverse cultural backgrounds, even without knowledge of other specific multicultural approaches.

Language

Although almost any other type of therapy would require the therapist and the client speaking the same language, play therapy does not. Because play is a natural and instinctive trait in children, spoken language becomes less important in this approach. American therapists trained in play therapy have been able to travel to other countries in disaster relief without speaking the language and still offer mental health assistance to children through toy kits.

Play as Conversation

Another benefit of play therapy is that words are not necessary to gain benefits. Play therapy is rooted in the belief that children use play as their language and toys as their words. Therefore, everything is communicated through what takes place in the play room, rather than what conversations occur. Additionally, children are often unable to verbally articulate feelings, emotions, needs, wants, and desires well, so they allow the toys and their play to speak for them to a trained therapist.

Play therapy offers an effective intervention for children, as the child and therapist need only to have a room full of play toys to conduct a session. They do not need to speak the same language, come from the same culture, or even have a conversation for it to be helpful and beneficial. And for kids, whose world begins to make sense when they are engaged in play, it offers a safe and fun environment with a therapist who can understand what does not need to be spoken.

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Adoption and Play Therapy

Brenna Hicks — Thu, 23 Mar 2017 18:10:54 +0000

I recently have had an influx of children who are adopted in my practice. This has reminded me of the unique challenges that families of adopted children face and that play therapy is extremely well-suited for them. Not only does it give kids the opportunity to address their experiences, but it also provides a method that doesn’t require conversation. This is especially helpful for children who were adopted in infancy or toddlerhood, as their memories are subconscious.

Attachment

One of the more common struggles for children who were adopted, especially from foreign countries, is that they must learn and develop healthy attachment. Filial therapy (training parents to use play therapy with their children) is especially helpful for this. As parents learn to unconditionally accept their children, and encourage communication through the natural process of play, kids begin to let their parents in, realize that they are safe, and that they long for healthy interaction.

Hoarding

Another common occurrence observed in children who were adopted is hoarding behavior, especially with food. This is well-suited for play therapy as well, because the play room is full of items and foods that the child can take, hide, control, use, and practice letting go of the need to stock pile things. Over the course of weeks, children realize that it is safe to trust people and places. They also learn that there are healthier ways to communicate their need for attention, care, and nurturing.

Traumatic Experiences

Although there are adoptions of newborns for whom this is not the case, there is almost always a history of trauma to some degree in children who are adopted. This is either due to neglect, abuse, insufficient attachment, or being removed from the care of biological parents. These experiences are usually too difficult to understand and become underlying issues as children grow older. Play therapy allows them to rewrite the ending, create a different narrative, rehearse the memories, or practice dealing with the situation so that it no longer seems as confusing, difficult, or scary.

Children who are adopted have their own unique challenges based on their circumstances. However, play therapy is well-suited and well-received. They have already been given a happier home environment, and through therapy they will become more well-adjusted and happy.

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Play Therapy and Divorce

Brenna Hicks — Thu, 09 Mar 2017 17:37:21 +0000

One of the most difficult things that a child goes through is the divorce of his or her parents in childhood. This not only impacts the emotional and behavioral health of the child, but it changes everything in the child’s environment as well. What was once part of the normal family routine is uprooted and shifts to two (sometimes very) different expectations. This change can be extremely difficult to navigate for kids, especially if they are prone to worry, anger, or control issues.

New Normal

Every family works toward their understanding of balance. Whether this is chaotic and crazy or quiet and calm, each family does not veer too far out of their “normal.” When a separation or divorce happens, kids are all of a sudden thrown into something completely different than what they are used to. This means that they are forced to adjust to their new environment, and accept that what they are accustomed to is no longer their reality. This “new normal” is not necessarily bad, but it is certainly confusing for kids and takes time to figure out.

Shifting Expectations

Whenever parents create separate households and kids go back and forth between homes, parenting styles influence family life and rules change from one household to the next. There are different bedtimes, different expectations, different wardrobes, different neighbors, different everything. Kids thrive on consistency, so when everything shifts it can be overwhelming and frustrating. This requires a lot of resilience and coping skills, which often kids lack until they are forced to build them.

Power Struggles

One of the consistent patterns is that when kids feel that their world spins out of control, like in a divorce situation, they will latch onto and grasp at any measure of power that they can find. This often means that refusing to comply to requests, resistance to rules, physical or verbal aggression, and argumentative postures are common. This is a child’s way of trying to make sense of everything turning upside down in their world, and they want to gain some semblance of control back in their lives.

Play therapy allows kids to work through all of these issues through the natural process of playing. They will play through power and control, obeying rules, scary circumstances, competence, resilience, and expectations so that they can better navigate the changes that are happening in their lives. This method gives them the time and place to process their feelings, fears, and desires, acting as practice for the real world.

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Childhood Diagnoses and Play Therapy

Brenna Hicks — Thu, 02 Mar 2017 17:29:12 +0000

I am often told by parents in the initial consultation that medical doctors have recommended a mental health diagnosis for their child, even if one was never officially given. This is always interesting for me, as pediatricians typically spend twenty minutes, once a year with children. (Please note that I am not implying that medical doctors are incapable of identifying concerns and issues in children at check-ups!) However, even when children seem to meet criteria for certain disorders, it does not immediately warrant a diagnosis.

I consistently tell parents that while I appreciate the information and concerns for certain diagnoses, it is not necessary for me to conduct play therapy with a child. In fact, I typically say that after play therapy and after addressing the social, emotional, and behavioral concerns, it would surprise me if the child still met diagnostic criteria for any disorder.

Pediatrician Recommendation

I recently was working with a three year old who went for his annual check-up. After a brief interaction, his mother was told by the pediatrician that he needs to be tested for Pervasive Developmental Disorder (PDD). What’s interesting is that PDD is an autism spectrum disorder, and this child DOES NOT have autism! After months of working with him, he does not meet criteria and his issues are emotional and behavioral in nature.

Play Therapy

This is why it is so important to pursue alternative methods of intervention for kids, as it is easy to just prescribe them medication or label them with a diagnosis, unnecessarily. Play therapy provides a drug-free option for parents who want to ensure that their kids are healthy and happy. They can work through their experiences, their struggles, their worries, and their emotions in a safe and neutral place. Then, they are much more well-rounded and calm because they had an outlet for their issues.

While there are certain chemical, physical, or physiological reasons for medication in childhood, they are often over-prescribed and over-used. In the case of play therapy, all of the other factors are addressed first. This allows for growth, positive change, and healing before medication is introduced.

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Kids’ Food Allergies and Play Therapy

Brenna Hicks — Thu, 23 Feb 2017 16:27:39 +0000

I recently worked with a child with a severe and debilitating fear about his peanut allergy. Even though his peanut allergy was closely monitored and managed by his parents and teachers, he became overwhelmed and consumed with exposure to peanuts at school, at home, at restaurants, at friends’ homes, and anywhere there was food.

Fears

It became scary to eat anything, because anything could have had peanuts around it or in it. His parents had to wash their hands dozens of times a day, were not able to touch his straw when taking it out of the wrapper, could not cook him anything to eat that didn’t come from a package – all for fear of contamination from peanuts, even if there were no peanuts around.

Backpacks, cafeterias, lunch boxes, cups, plates, silverware, counter tops, fingers, clothes, and especially food were all unsafe. He lost seven pounds because he wouldn’t eat anything. Interestingly, he genuinely wasn’t being defiant for power or control like some kids with eating issues. His was birthed from genuine fear and overwhelming paranoia that he would end up in the hospital or die from exposure to peanuts.

Intervention

Play therapy helps address issues like these in two major ways. First, kids are given the opportunity to play out exposure to their fears in a safe and contained environment. They can pretend to eat a peanut and see what happens. They can practice keeping themselves safe when unknown food ingredients are around. They can also work through irrational fears by proving to themselves that they are brave.

Another outcome to play therapy relating to food allergies is that kids build coping skills. As kids engage in control play, they take charge of things in play to combat those areas in which they feel out of control in their lives. They also engage in competence play so that they can test themselves, thereby demonstrating that they are capable of trying, failing, and succeeding without fear of repercussions that they would experience in the real world.

Outcome

Within ten sessions of play therapy, this boy made a remarkable turn around and conquered his fears. He started telling me stories each week of eating pizza with his football team, eating out of a communal bowl of chips, watching his sister eat peanut butter and knowing that he would be okay, and not insisting that his mom washed her hands every five minutes while cooking. He was able to overcome a pervasive fear through playing – and without ever having to talk to me about what was so scary for him!

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Play Therapy and the Court System

Brenna Hicks — Thu, 16 Feb 2017 17:03:47 +0000

I have recently been receiving more referrals from family attorneys whose clients are in the middle of heated and difficult custody battles. Understandably, the kids are struggling to make sense of the new situation and are absorbing some of the anger and worry of the circumstances. Sometimes, during or after treatment, I am asked to write up a report for an attorney based on what transpired during therapy. Other times, I am called into court as a witness in the case.

In either circumstance, I have become aware of a pervasive belief within the legal system regarding play therapy: it is misunderstood and criticized needlessly. Attorneys and judges want to know if there is empirical validation for the intervention (the answer is yes). They also want to know how I determine what is going on, and how I make decisions based on what is in the best interest of the child (the answer is hard to explain). Finally, they are not sure how playing with a child teaches me anything about the situation or helps with the presenting struggles and concerns (the answer is play is a language).

Empirical Validation

Studies have been conducted on play therapy and its effectiveness for decades. Without boring you with all of the statistical details, play therapy has been shown effective for almost every childhood concern – behavior, abuse, trauma, attention, focus, aggression, divorce, grief, move, and more. Children gain coping skills and internal resources while they play with a trained therapist to help them process where they are and what they want to change. Data shows that play therapy produces a reduction in unwanted behaviors and an increase in desired behaviors.

Play Themes

There are thirty or so play themes that typically emerge in play therapy with children. Kids will only process a few at a time, and will continue playing that theme through until they reach closure or reconciliation. Trained therapists are able to connect what is happening in play to where the child is in real life. The therapist also recognizes that certain themes relate to situations and traits. Further, themes follow a hierarchy as needs are met before wants.

Toys as Words

One of the basic driving principles of play therapy is that play is the child’s language, and therefore toys are his words. What kids do not have the verbal or cognitive ability to express can be communicated through playing. If the child needs to create a better ending to an event, he does so through re-writing the story through play. If the child needs to feel more confident, he will use toys to practice building self-esteem and learning of what he is capable. No matter what the child needs, she can create the solution through play when a therapist works with her to do so.

Psychology Vs. Counseling

Finally, another interesting phenomenon is that opposing counsel is often quick to dismiss my credentials, citing that I am “not a psychologist.” That is completely true, but irrelevant. Child-centered play therapy is rooted in counseling, not psychology. Psychologists are trained very differently, and approach treatment with different tenets and foundational principles. While there are pediatric psychologists who have been trained in play therapy, it is still centered in the fundamentals of counseling practice. My PhD is in counseling, which allows me to focus on children’s mental health while exclusively implementing play and filial therapy with my clients and their families.

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Phases of Treatment in Play Therapy

Brenna Hicks — Thu, 09 Feb 2017 16:10:19 +0000

Just like learning to play a sport or learning to read, there is a set process for mastering the fundamentals, typically broken down into smaller steps or chunks. Similarly, one of the most important elements of the play therapy process is the four phases of treatment. Kids go through a very specific progression, and it is helpful that parents understand what to expect.

Initiation Phase

In the first phase of treatment, many things take place. More than any other objective, a rapport and bond is built between the child and the therapist. The child learns what to expect, and that play therapy is safe. A relationship is established as they get to know each other and learn more about each other. The child understands that the therapist can be trusted. And the child becomes familiar with the process, the toys, and the expectations for treatment.

Resistance Phase

As with any client, adult or child, resistance is a natural part of therapy. The client comes to the crossroads where all of the easy and nice stuff has been processed. So, the child has a choice to make – I can either dig in and face all of the things that need to be addressed, or I can fight it because it is scary, uncomfortable, and difficult. This process typically is observed as acting out emotionally or behaviorally, either at home or in the play room. This is usually a brief time period, but it is significant in the process. As soon as the child realizes that she can handle therapy, and that she is brave and strong enough, the bulk of the progress begins.

Work Phase

This is the phase where the child is fully invested in the process and working hard to address all of the issues and struggles in the play room. The child is continually healing, growing, and making progress on all of the areas of concern. This is also the time frame in which you will be able to notice the most marked changes in behavior, emotions, interaction, and communication. The child begins to demonstrate better coping skills, self-regulation, and resilience.

Termination Phase

This final phase of treatment is centered around termination of treatment. This is necessary so that children feel equipped and prepared to continue without therapy and without the therapeutic relationship. This is also an opportunity to create a healthy and happy goodbye for children, who typically experience negative associations with goodbyes. The child and the therapist reflect back on all of the things that were addressed, and a celebration of the progress and growth marks the final session.

Each phase in treatment is equally important and serves a distinct and significant role in the play therapy process for kids. And while every child is different and takes a different path toward healing in treatment, every child engaging in play therapy will progress through these four phases.

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Progress in Children’s Therapy

Brenna Hicks — Thu, 02 Feb 2017 15:52:17 +0000

It is interesting to consider how different children are than adults. We often forget that although they are smaller beings, they actually think, act, and process very differently. And therefore, they can’t be expected to fit into the same timeline, path, or journey as adults in therapy. As a result, I often explain to parents that their understanding and awareness of how things will go needs to be flexible and fluid. Kids live in the here and now, so their responses and reactions to therapy are largely tied to their emotions in the moment. They don’t process problems in a linear, sequential, or chronological fashion. In fact, while adults can go logically through the chain of events or history and recall what happened in order, kids are more like a heart rate monitor with jagged ups and downs, jumping around all over the place.

Consistency

However, even in their own way, there is consistency and themes that emerge with children in therapy. In 50 minute sessions in the play room, they might bounce around to five different topics and seem to follow no pattern. However, looking back over four or five sessions, there are always connections and repetitive play, indicating that they are working through a struggle.

Brevity

Another interesting element to therapy with kids is that they don’t stay focused on the issue for very long. Often five or ten minutes is all they can handle, and they go back to playing with something else that requires less emotional processing. Although those therapeutic bursts are short, they are significant and helpful in the healing and growth of the child.

Permanence

A final difference for kids in therapy is that often their progress is not a straight upward line on the graph, either. I like to explain it as more of a vertical zig zag, as they test and try and navigate new skills and tools. They usually feel comfortable with their old patterns of behavior, because that was safe and normal before treatment. So, sometimes it takes some back and forth before the new patterns stick permanently.

Regardless of what issues a child is facing, they handle the process differently than adults. As long as there is an understanding and acceptance of that difference, both parents and kids can walk the therapeutic journey with confidence and contentment.

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Play Therapy Toys

Brenna Hicks — Thu, 26 Jan 2017 15:50:19 +0000

Many parents walk into my play room and are a little surprised by the explanation of the importance of the toys. I am very careful to communicate that play room toys have been specifically selected, not collected. They either fall into one of three main categories of toys, or they are therapeutically useful in another capacity.

Much research and observation has gone into what should (and should not) be included in a play room. The overarching belief is that the toys should be basic and traditional, so that they can be creatively used in any capacity. They should represent things that make sense to the child, to connect with his world or experiences. And they should be organized in a way that seems purposeful and related.

Acting Out/Aggressive Toys

Acting out/aggressive toys are designed to allow kids to express negative feelings and process challenges. These toys include knives, swords, guns, handcuffs, shields, walkie talkies, army men, masks, and bop bags. This category allows kids to create a difficult situation so that it can be redeemed or fixed. And it also allows for limits when necessary and the understanding of consequences to choices.

Real Life Toys

Real life toys are designed to provide a child with the ability to play out any scenario that would take place in everyday situations. This would include family interactions, going to work/having a job, using household objects, making dinner, getting groceries, and caregiving. This gives them the opportunity to practice tasks and skills that are required in daily living.

Creative/Emotional Expression Toys

Creative/emotional expression toys are designed to allow the child to test his abilities and implement problem solving skills. This would include jump ropes, art supplies, craft materials, rocks, wooden blocks, and musical instruments. This category is especially helpful for kids who are building self-esteem and self-confidence.

Other Useful Items

Aside from toys that fall under one of the three categories, there are other useful and therapeutically beneficial items that are typically found in play rooms. These might include puppets and a theater, dress up clothes, a tent, an art center, board games, and a doll house.

When kids come into a play room, they need to feel that the space is inviting, relaxing, and organized. It is important that they know where to find the same item each week, as this helps them balance the chaos and confusion of their world. Plus, the more neutral and basic the toys, the more the child makes them what they need to be as they grow and heal.

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