Play Therapy: Trauma, Stress and Dysregulation

Often I am asked by curious, perhaps sometimes skeptical parents, what Play Therapy is and how it will help their child be calmer, more resilient, more mentally healthy. Play Therapy is the preferred approach in working with children, speaking to kids in their language of choice. Each model of Play Therapy has something unique to offer and can be beneficial in its own way; however, when it comes to working with children’s stress, trauma and their emotional (and therefore behavioral) dys-regulation, it is critical to have a Play Therapist who understands the biological mechanisms of stress and its impact on the developing nervous system.

Leading trauma author and researcher Dr. Peter Levine says, “Trauma happens when any experience stuns us like a bolt out of the blue; it overwhelms us, leaving us altered and disconnected from our bodies. Any coping mechanisms we may have had are undermined, and we feel utterly helpless and hopeless,” (from Trauma Through A Child’s Eyes by Peter A. Levine and Maggie Kline) The flight/fight/freeze response in our brain has been activated in response to a perceived threat, neurochemicals and stress hormones are released signaling to the brain and body to either mobilize (fight/flight) or to “play dead” (freeze) and the nervous system is flooded with information. When the danger has surpassed, if we are not able to discharge the flood of nervous system energy and integrate the experience, it will likely be stored in the nervous system and the body as trauma and can be debilitating to the life of the individual, particularly to children.

How Can We Help Children Move Through A Traumatic Experience

Integration refers to the linking of different parts of the brain in order to help them function well together. Trauma is primarily a function of the brain’s right hemisphere, which is more closely associated with the lower, or more primitive parts of the brain. In fact, our fight/flight/freeze response is governed by our brainstem, the very back of the brain close to where the back of your head meets your neck. In order to heal from trauma and integrate an experience, we must create connections between the sensory information that is stored in the right hemisphere (the imprint of the traumatic experience) and the rest of the brain, particularly the left hemisphere and the pre-frontal cortex (the area behind your forehead responsible for more sophisticated functions such as rational thought, sequencing of events, empathy and intuition, etc.)

Now that you know a bit about the biology of stress and trauma, what can you do in the aftermath of a frightening event to help a child calm his/her nervous system and ultimately to integrate the experience? Here are some pointers:

• Use the oxygen mask philosophy: attend to your own state of regulation and do what you need to do to regulate: deep breaths, feel into your body, shake your hands out, feel your feet on the ground, say a calming phrase to yourself (such as, I am ok).
• Attend to your child’s basic needs first—safety, human touch (rubbing his back, holding her hand), nourishment (a glass of water), rest.
• Maintain an authentic attitude of empathy and compassion. Even if your child was in the wrong in some way (i.e. made a mistake and fell off his bike), now is not the time to discuss this. Let him know he is safe now, that you are here, that you’ll talk about the details of what happened later and that now is the time for him to just get safe and calm himself.
• Repeatedly orient your child back to his/her body. Ask her to feel her feet on the ground. Tell her to let you know where it hurts or what it feels like right now. If she has a specific sensation, ask her for more detail about this. Does it have a color, a size, a shape? As humans, one of our coping mechanisms during trauma is to dissociate or “check out”. One way to keep the trauma from developing into Post Traumatic Stress Disorder is to interrupt this dissociation by “getting back in the body”.
• Crying, trembling, shaking and movement are normal and healthy once the shock of a traumatic experience has worn off. Allow this to happen naturally and stay present with your child while he/she releases these waves (this is energy that has built up in the nervous system as a result of the frightening experience and it needs to be discharged). Assure your child that this is normal and it’s ok to cry or shake.
• When the child is calmed again, has rested and had his/her basic needs tended to, now is the time to talk about and integrate the experience. This is the time in which parents can ask questions and allow the child to tell his/her story. Draw a storybook or comic describing his memory of the experience, focusing on how it felt for him/her. This allows integration between the two hemispheres of the brain and can lead to greater resilience and healing from the experience.

When To Consult a Professional Play Therapist

There are times when we are not able to fully help our children integrate and bounce back from an experience. Here are signs that it may be time to consult a Play Therapist with a background in trauma work to help your child process and feel better:

• Changes in personality or drastic changes in behavior
• Regression: suddenly acting younger than his/her age, reverting to old stages of development—reverse progress in potty training, sucking thumb, talking baby talk, bed-wetting
• Mood swings and/or the child is unusually sullen, sad, angry or controlling
• Unusual themes and feelings in the child’s play that suggest he/she is working through an overwhelming experience
• Sleep disturbances, Nightmares
• Social withdrawal or isolation for a previously social child
• Changes in appetite and eating habits
• Physical symptoms that don’t have a traceable physical cause

How Play Therapy Can Help

Here is how Play Therapy with a trained and experienced Play Therapist can help your child move through this difficult time and come back more resilient, confident and emotionally regulated.

As humans we are inherently relational, using our relationships to learn about ourselves, develop confidence and to heal when we are facing or have faced a challenge. Play Therapy offers children a unique relationship in which they can express their internal world and explore their struggles in a highly supportive and compassionate environment. As children express themselves, the therapist facilitates the processing and integration of stressful or traumatic experiences. Through their play, shifts in the biology of the child’s brain and nervous system are able to take place thus allowing the child more ease and fluidity in nervous system regulation. This shift leads to greater resilience, the ability to regulate stress and more ease in the expression of one’s emotional experience and states through words rather than through behavior.

Play Therapy is the research-based method of choice for helping children with a variety of issues including, but not limited to PTSD, depression, anxiety, abuse, behavioral challenges, adoption, divorce or separation, separation anxiety, grief and loss, sleep or eating disturbances, bed-wetting, impulsivity, social challenges and more.