Skip to content

A NeuroDevelopmental Approach to Treating Children with Complex Trauma with Play Therapy

January 24, 2019

I’ve discovered over the years that the story of my play therapy journey is not unique. I first danced with the identity of play therapist early in my career- fresh into the field with my master’s degree training (which included a course in play therapy) and a handful of CEs. I was working pretty exclusively with children with what we would now call developmental or complex trauma- back then, we just had the diagnosis of RAD as a framework for treatment planning, case conceptualization, and intervention.

I was really struggling with using my play therapy skills with that population. Uncertain about my theory or my skills- maybe I was just a bad therapist!!!- I found a mentor who specialized in the same population (oh bless you, Steve Terrell and your willingness to take on my fumbling and exploring- you changed the trajectory of my career) and he helped me see the need to expand beyond the play therapy skills I had in my tool box. I jumped into trauma trainings- including EMDR and somatic experiencing. I immersed myself in attachment theory and later, Interpersonal Neurobiology. I continued to engage in play therapy trainings along the way, but primarily focused my educational pursuits outside the field of play therapy. But obviously, I was indeed PLAYING with children and definitely, play was the primary intervention.

However, I was coming into my identity as a little bit different kind of play therapist. I discovered right away that I could not keep a child-led play therapy office. It was DESTROYED and also- just didn’t feel right. There were moments where I felt whip-lashed by a tornado of chaotic energy and couldn’t figure out how to help. It was like watching someone flail in dark waters, terrified of drowning, and having no skills to help or even a life jacket to toss their way. Just like a drowning individual cannot be expected to use their “self-organizing drive toward healing” (which does in fact exist in ALL OF US) I couldn’t expect that from these children. I can now articulate that the children in my office were not neurodevelopmentally ready for toy-based play. They certainly hadn’t progressed to symbolic or metaphor-based play. Regardless of age, their neurodevelopment simply lagged far behind due to the severity of the abuse and neglect they experienced. They needed highly engaged, highly sensory, and highly relational experiences for containment and coregulation.

But I didn’t really understand WHY this was true. Why wasn’t child-centered play therapy ‘enough.’ Was I doing it wrong (totally possible)??

Along the way, I stumbled across the works of Bruce Perry, Bessel van der Kolk, Daniel Siegel, and my now mentor, Bonnie Badenoch. There was certainly a common thread- the RELATIONSHIP is the primary healing agent in all therapies, and completely non-negotiable for children with relational trauma in their history. But these weren’t play therapists. So I integrated what I was learning about trauma, attachment, and engaging the body in the therapy room. I listened to experts in the field of attachment trauma about the importance of involving families in the therapeutic experience. And sure enough, the kids I was treating were in fact getting better.

A few years ago, I came back around to feeling the pull toward the field of play therapy. Play therapy is so inherently body-based, so inherently right-brained, so inherently ‘beyond words.’ Neuroscience is now so clear about how play in and of itself is healing to the traumatized nervous system, as well as a trait of a healthy nervous system (Panskepp, Porges, and others….). Plus- I was seeing a troubling theme in families feeling as though therapy with a play therapist wasn’t effective for their child with complex trauma. Many of my clients were coming to me after previously engaging with another therapist- GOOD therapists- but often a more traditional child-centered play therapist. They complained of feeling excluded from the process and little to no progress being made. They were floundering, didn’t know how to parent their child with what felt like extremely bizarre behaviors, and like failures as parents because traditional parenting strategies were not working. But there are so so so many fantastic play therapists out there, and play is the absolute more PERFECT intervention for children with complex trauma. I had to figure this out.

I dove harder into finishing my Registered Play Therapist credential. I had already accumulated about 2/3 of the educational requirements but needed to finish them up. I also needed to find a great supervisor- one who could support my curiosity and interest in practicing just a little bit differently from a traditional play therapist. Luckily, that person lives right here in Austin (Marshall Lyles– the world’s greatest play therapist and supervisor).

Finally, I began to get closer to clearly articulating my approach to play therapy and the WHY behind my approach, and I discovered that where my instincts were leading me is wildly supported by research.

The brain develops sequentially- in order- from the bottom-up. Children with complex trauma, including abuse and neglect, are impacted in the very lowest parts of their brain. The lack of attunement and presence in their earliest moments has left them without a sense of self- who they are. They feel disorganized, chaotic, and empty. They don’t invite us into relationship and often times it doesn’t feel good to be with them. Thus, they continue to re-enact their trauma of abandonment and aloneness by pushing people away and making it feel as though they don’t even want relationship (they do- promise).

Bruce Perry’s work taught us that the lowest parts of the brain need rhythmic, repetitive, relational, and somatosensory experiences in order to organize and heal. Dr. Perry is able to bring together the truth that RELATIONSHIP and following the child’s lead is non-negotiable (play therapists are good at this!!), yet we can do those things while still being strategic about the types of experiences we offer to the child in order to best support their underdeveloped brainstem. He helped me conceptualize why these precious children would destroy my room and spin in their own trauma and disorganization.

Bessel van der Kolk taught us that we MUST incorporate the body into trauma treatment. We can no longer divorce the brain from the body in any psychotherapy, especially not trauma work.

Studying some of the experts in the occupational therapy field helped me weave together why the sensory deprivation that is inherent with trauma, abuse, and neglect in early childhood is directly related to the attachment cycle- and a way to strengthen attachment is to engage, soothe, and heal the body. The sensory experiences in infancy- combined with the presence of an attuned caregiver- weave together who we are. Literally. Without those experiences, we are chaotic, disorganized, confusing, and almost impossible to engage in relationship.

And immersing myself into Daniel Siegel’s then emerging field of Interpersonal Neurobiology, ultimately studying intensely with my now mentor Bonnie Badenoch, helped me pull all these pieces together. The relational neurosciences are the best we have right now at defining abstract concepts like presence, attunement, and resonance. My work with Bonnie- who is just a genius in curating and bringing together diverse sciences and ideas- has helped me embody these ways of being. She has taught me WHY that lack of presence in early infancy is impacting the children so profoundly, and why it’s not enough to just SAY ‘the relationship is the healing agent’ but to really dive in and figure out how to BE relationally in the therapy space in a way these children need. And that this isn’t something I can learn from a book. I learned it…and continue to learn it….from engaging relationally with others- including Bonnie and my own therapist. And friendships and professional experiences that also value this experience of alive, resonant, ways to being together.

The relational neurosciences now support therapy interventions that target the appropriate neurodevelopmental need of the client. Children with early complex relational trauma first need to rebuild a solid foundation through movement, rhythm, and sensory play. They need this in ALL parts of their lives, not just one hour of therapy per week. They need this embedded in a resonant, dynamically present therapeutic relationship (and ideally, their relationship with their caregiver). Working with clients in this way is intense! It requires a lot of energy, a lot of presence, a LOT of self-knowing, and a lot of humility. Sometimes this can be misperceived as being ‘directive’ or not following the child’s lead. This is quite the contrary. This type of therapeutic work with children requires an INTENSE amount of attunement and understanding of the follow-lead-follow dance of attunement, attachment, and resonance. It requires therapists to be fully alive and meeting their client’s in the exciting “WE” space that is co-created moment by moment. Children with complex trauma need to ‘take in’ the attuned, present, and resonant other. We allow them to do this because of our dynamic and not passive presence. Their mirror neurons soak us up, laying the building blocks for their sense of self AND regulation.

This is intense work. This is not how I was trained! And this is not how I experience most therapists as being trained or supported by their consultants or supervisors.

As the foundation gets stronger, as their sense of self develops and organizes, children will naturally move toward more expressive or symbolic ways of playing in therapy. The same way children naturally progress with their language or gross-motor skills, children naturally progress through their neurodevelopment. When children move into this next stage of treatment, I open up my room to look more child-led. Because we are complex, self-organizing systems, I trust that now that they have a more embodied sense of who they are, their systems will continue to move toward coherence and organization- as long as I continue to provide them with my authentic, attuned, resonant presence. This is not a time for relaxing, but there is a felt-sense of a more mutual relationship with a more defined little person in front of me- the same way this feeling changes as children grow from newborn, to early infancy, to late infancy, to toddler. We feel them becoming themselves.

Rlgobbel 5 feb-01

 

And then as needed, we begin to engage the cortical parts of the brain. We may identify ‘mixed up thoughts’ or talk specifically about coping skills. ALWAYS I do this through the medium of play (symbolic, movement based, sensory…I’m using play to describe a wide variety of different ways of being) so that we are embracing whole-brain learning as much as possible. We may create a specific therapeutic narrative, writing a book or making a time-line. We may do EMDR to target specific traumatic memories or desensitize present-day triggers.

I don’t want to imply that children progress through this in a beautifully sequential manner. First this, then this, and next this. Oh, how I wish. This brings us back to why it is SO important for therapists to ALWAYS be working on developing their own embodied presence and sense-of-self. This is infinitely more important that any tool, strategy, or technique (though obviously those are important, too). Therapists must be supported to engage in ongoing opportunities where they are invited to explore themselves inside a resonant relationship. When we are able to be fully present and attuned, tracking ourselves tracking our clients, it becomes easier to track treatment that isn’t sequential. To flexibly move in and out of different stages of treatment as the child needs.

Which brings me to my next big goal and project. Play Therapists…stay tuned. I’m working closely with Marshall Lyles to create exactly that. An ongoing, intensive experience where we weave together play therapy skills and strategies with a fearless pursuit of ourselves. It is going to be breath-taking.

UPDATE!!!  In the meantime!  Catch my introductory webinar that was inspired by the popularity of this article- A Neurodevelopmental Approach to Treating Complex Trauma with Child & Play Therapy.  Children with complex trauma need us as play therapists to ‘meet them’ in the foundation of the brain.  We’ll bring in rhythmic, repetitive, relational, and somatosensory play and under consider why children with complex trauma need MORE presence, more engagement, more resonance from their therapist!

Webinar airs Wednesday September 18 at 12pm eastern, but you DO NOT have to attend live!  CLICK HERE for all the details!

Until then…

~

email signature_smaller

Like what you read here? To get even more support, click here to sign up for my newsletter! I try to send it out monthly. Sometimes I succeed. Mostly I don’t 🙂

Robyn Gobbel, LCSW, RPT-S is a child and family therapist in Grand Rapids, MI- though she is currently focusing on teaching, training, and consulting with other therapists so that there are MORE therapists skilled in working with children with complex trauma.

6 Comments leave one →
  1. Robert Hafetz permalink
    January 24, 2019 10:03 am

    Instead of saying play therapy lets expand the term and use experiential interventions. The limbic system can understand cognition or verbal interventions making CBT useless. Play is the language of children but non play experiences created by caregivers can be powerful healing interventions. That means healing traumas will occur not in the office but in the home environment. We must teach parents how to respond in healing ways which tend to be counter intuitive. Good article.

  2. Linda Miller permalink
    January 24, 2019 12:10 pm

    Dear Robyn, For 10 years I have been an adoptive parent in Boise Idaho where there aren’t many options for kids with complex trauma. I appreciated your recent post about play therapy. It prompted me to write to you and ask about the Reggio Emilia approach to early childhood education.
    If you are unfamiliar with this model I hope you will do a google search to see what it is. I have this hypothesis rolling around in my brain that this would be an ideal model for children with complex trauma to be used in the school setting and also the therapeutic setting. It could even be a way to integrate them both.
    We have no day treatment options in Idaho for kids who cannot tolerate the school setting so I have been trying to gather some folks together to start a therapeutic school. I haven’t made very much progress. I am interested in learning how other schools operate and if this model has ever been used in a therapeutic setting. If not, I hope that I can spark your interest in looking into it. I would encourage you to search out a school or class that uses this model and observe it in action and speak to a teacher trained in this model. You may be able to see how it can be used.
    >

  3. Kate permalink
    January 26, 2019 11:36 am

    Thank you for addressing the play therapy vs relationshipping. We’ve had that experience of chaotic, whirling dervish play therapy for our son, without any apparent goal or progress. Our 5 year old is unable to amuse himself at all, needing constant moment to moment engagement. If I disengage even long enough to make a ‘phone call or go to the bathroom, he starts with negative behaviors to pull me back into engagement. And his constant cry is “play with me, Mommy”, but he can’t actually play. He holds toys, talks about them, but can’t play. My experience is of a kid who demands non stop, from waking to bed time – I’m so exhausted! His experience looks to me, like someone who has a desperate need and just can’t get it met, but god love him, this kid keeps trying. It’s an itch I’m not scratching. There’s a piece missing and it’s the piece where he needs that relationship hole filled with more than just attempted play and time with Mommy. Would it be possible for you to address the play/relationship piece for parents? What does that sensory, rhythmic, relationship building look like for the minutes and hours and weeks and years of parenting a kid who just isn’t ever filled?

    • January 27, 2019 4:05 am

      Hi Kate!!! Your experience is so common…I’m sorry! The Adoption Connection podcast is running a two part series with me in a few weeks. Look for that! We talk about the sensory, rhythmic, relational piece the whole time. I also teach a 5 hour online course in the summer…look for that! Have you looked for a Theraplay therapist or someone trained in Bruce Perry’s NMT for therapy?

      It’s a little less that your precious boy isnt filled…and more likely that he still doesn’t have an internalized sense of self or other. Theraplay could help with that. Best of luck.

      • Kate permalink
        January 27, 2019 7:56 am

        Thanks so much for your reply. I’ll definitely look for the podcast and the course in the summer. Unfortunately we don’t a certified theraplay therapist in our area, but times are changing and hopefully as the groundswell of trauma knowledge and services spreads, we’ll start to see more here. Thanks again.

  4. January 31, 2019 10:10 am

    This sounds great! I can’t wait to hear!

Leave a Reply

Fill in your details below or click an icon to log in:

WordPress.com Logo

You are commenting using your WordPress.com account. Log Out /  Change )

Google photo

You are commenting using your Google account. Log Out /  Change )

Twitter picture

You are commenting using your Twitter account. Log Out /  Change )

Facebook photo

You are commenting using your Facebook account. Log Out /  Change )

Connecting to %s

%d bloggers like this: