AAMFT Annual Conference October 2013 Solution Focused Play Therapy with Children and Families Workshop Overview I. Philosophy and Assumptions of Solution- Focused Brief Therapy (SFBT) II. Debunking Myths of SFBT III. Play Therapy and Families IV. Debunking Myths of Play Therapy V. Empirical Support for Play Therapy VI. Demonstration of Solution-Focused Play Therapy with Families VII. Role-play/Case Scenarios Pamela King, M.S. Amber Willis, PhD Darryl Haslam, PhD Key Figures: Steve deshazer & Insoo Kim Berg Overview of Theory: Emphasis on solutions, instead of problems Focus on solutions in session, not on problem Problems = Unsuccessful solutions Post-Modern Roots: Collaborative therapeutic role Emphasis on languaging and planting suggestions Client self-determination and problem definition Principles about Problems and Change: People are constrained by narrow, pessimistic attitudes about life and self They get saturated by problems and can t see solutions to them Must open their minds to new possibilities Change is inevitable in life and in families, so small, meaningful changes are effective Language: Focus on how people talk about problems Language creates reality. (DeShazer) Key Aspects: 1) Future-focused: Little emphasis on past issues - Don t need to know much about problem to solve it - Addressing what people want vs. what s wrong 2) Resistance: Rejection of the idea of resistance - Humanistic roots: Client/family motivation and ability to change - Post-Mod: Resistance = Wrong way in tx focus 3) Time-limited: Designed as a brief therapy - Focus on small but meaningful changes in client system Over-Arching Goal in Therapy: Switching from problem talk to solution talk Clients are encouraged to steer from problem talk to solution talk What would Mom see you doing to say it s going better? Therapist helps client reframe their issues via languaging them differently It sounds like cares about you a lot to be so concerned. Key Focus in Sessions: Talk about potential solutions instead of about past problems and empowering clients to see solutions 1
Specific Aspects of Goals in Session: Focus on presenting complaints Brief therapy metaphor of Mechanic Repairs Emphasis on helping clients think or do something differently State goals in positive terms: More... Goal clarification is a central activity and a dynamic, continual process during therapy Not a one-time or static process Goal Setting in Session: Help clients translate big goals into attainable objectives and determine how would they be measured Help establish concrete measurable indicators of their progress Often in terms of behavior or actions that reflect mood or thinking changes Collaborative Goal Setting: Mom & D Build Together Application with Children: Goal Setting Assumptions SF Assumptions in Systems & Play Families/Children are Unique, Parents Play Important Role Parents Want Child to be Well Children are Amazingly Creative Activities/Toys are Conversational Tools (rather than diagnostic) (core assumptions cont.) Aspects of Therapeutic Change Process: 1) Help clients shift from talking about problems to talking about solutions 2) Help clients find and/or recognize unseen solutions to problems Help the client recognize times they were already making the problem go away (i.e., Wizard of Oz) 3) Then, get them to do more of these solving actions (will reinforce further changes) Steps in Therapy: 1) Assess client system s readiness to change 2) Find exceptions to the Problem: Assess for possible solutions that may already be present. Examples: What is going on when it is different? What are you doing or thinking when things are better? What would others notice about you? What will change for more of this to happen? Steps of Therapy: (cont.) 3) Plant seeds of change and hope via carefullyworded phrases or suggestions Amplify exceptions to help clients feel like solutions are possible 4) Instill a Vision: Help clients imagine and discuss what their lives will be like when things were better Be specific in behavioral or cognitive terms 2
Examples of Validation Statements: What have you done to make the problem less or go away? How have you done as well as you have, given all that you ve been through? Wow, you must be a strong person... Look at how much you ve survived... What things have you done well...? Key Interventions/Techniques: 1) So-if questions: So, when[that issue/problem] is better, will it solve your problems? 2) Scaling Questions: On a 1 to 10 scale, how would you rate your sense of hope in life right now? When we re done? 3) Reframing (same as other models) Interventions/Techniques: 4) The Miracle Question If you woke up tomorrow and a miracle happened, and your key problems were gone, what will be different about the way you act, feel and think? Be detailed in behavioral descriptions Variations: Magic wand or three wishes 5) Formula first session task: Ask clients to observe over the next week what things are going well (or they want to continue) Application with Children: Future Play Interventions Preferred Futures Importance of Role Play Experiencing Better Getting Details Shrinking Fear Ball Angry to Calm Debunking Myths in SFBT Problem Phobic or Solution Forced Clients need to be highly motivated SF is effective with difficult clients/ cases Sexual Abuse (Yvonne Dolan) Child Welfare Family Services (Berg) Suicidality (Fiske) Substance Abuse (Pichot, Smock)(Berg, Miller) Is accepted as evidence-based practice SAMHSA, NREPP, & OJJDP What is Play Therapy? Play Therapy: Originated in early 1900s Incorporates toys/play materials to help children express thoughts & feelings, preferred futures Toys are a conversational tool in SF Draws on creative art, puppet/doll, psychodrama, games, and sandtray activities Axline, 1947; Freud, 1946; Landreth, 2012; Selekman, 1997 3
Debunking Myths of Play Therapy Play Therapy (PT) is just playing with toys PT is a theoretical orientation PT is a voodoo approach without clear theories, interpretations or research PT is a new thing or a therapeutic fad Play-related techniques cannot be used in adult or family therapies PT set-up is too costly to be practical Play Therapy and Families Perceptions About Play Therapy: Play therapists often focus heavily on working with the child in therapy Family therapists often focus on families in child-focused cases Both groups have often maintained a perception that play therapy is mostly just for children This attitude limits how play therapy can be used with families and in situations where adults or teens are present Haslam & Harris, 2011 Family Play Therapy Family Play Therapy (FPT) balances: The use of developmentally appropriate methods with children and a clinical focus on the family system - FPT gives the family therapist effective techniques for engaging children - FPT evokes the family s creativity & spontaneity The integration of play with family therapy strengthens both therapeutic approaches Eliana Gil (1994) Family Play Therapy Benefits of using FPT: Engages all family members, giving children meaningful ways of being involved Reveals the family s dynamics in powerful ways Utilizes healing properties of play and diffuses anxiety Creates powerful symbols and meanings for families Allows the family to share in the problem and its solution Gil, 1994; Lund et al., 2002; Sori, 2006 Family Play Therapy Empirical support for PT and FPT PT shown to be effective with diverse age range of children w/variety of clinical problems Tx effects similar to non-play child tx (e.g., CBT methods) Most powerful effects found when parent is conjointly involved in child s tx FPT associated with Greater child participation Improved quality of child-therapist alliance More positive emotional experiences LeBlanc & Ritchie, 2001; Ray & Bratton, 2010; Willis, Walters, & Crane (in press) Solution-Focused Play Therapy: Bringing Miracles to Life Scaling Tools Abicus, ladders Checkers Marbles, steps on the floor Video Examples Counting to Calm Hopscotch Scaling 10 Footsteps/Race Sandtray War and Peace 4
E.A.R.S. A Solution-Focused Guideline and Tool for Practitioners Elicit Ask about positive change. Amplify Ask for details about positive change. Reinforce Make sure the client notices and values positive change. Start Again Go back to the beginning and focus on client-generated change. Adapted from DeJong and Berg, 1998 Solution-Focused Play Therapy: What s Better Second Session and Beyond E.A.R.S. What has gone well? What is better, even a little bit? Examples Angry to Calm: Thinking The Right Track Earn a Chip: Play a Game Self Esteem Chains Solution-Focused Play Therapy: Additional Interventions Ending Treatment Review how child made changes Family Collage Of the new family they ve become Accomplishments made over therapy Positive things family wants to be doing in future Graduation Celebration: Thank You Cards Contact Info Pamela King, M.S. Pam@LifeDirectionsCoaching.com Amber Willis, PhD willis.amber.b@gmail.com Darryl Haslam, PhD DHaslam@MissouriState.edu 5
Suggested Readings/References Axline, V. (1947). Play therapy. Cambridge, MA: Houghton Mifflin. Berg, I. (1994). Family Based Services. New York: W.W. Norton & Company. Berg, I. & Dolan, Y. (2001). Tales of Solutions. New York: W.W. Norton & Company. Berg, I. & Miller, S. (1992). Working With the Problem Drinker. New York: W.W. Norton & Company. Berg, I. & Steiner T. (2003). Children s Solution Work. New York: W.W. Norton & Company. Bratton, S., Ray, D., Rhines, T., & Jones, L. (2005). The efficacy of play therapy with children: A metaanalytic review of treatment outcomes. Professional Psychology: Research & Practice, 36(4), 376-390. Brewer, A. L. (2010). Thank-you cards. In L. Lowenstein (Ed.), Creative family therapy techniques (pp. 301-303). Canada: Champion Press. Budman, S., Hoyt, M. & Friedman (1992). The First Session in Brief Therapy. New York: Guilford Press. Cade, B. & O Hanlon, W. (1993). A Brief Guide to Brief Therapy. New York: W.W. Norton & Company. Dolan, Y. (1998, 2000). One Small Step-Moving Beyond Trauma and Therapy to a Life of Joy. Nebraska: Authors Choice Press Dolan, Y. (1991). Resolving Sexual Abuse. New York: W.W. Norton & Company. Fiske, H. (2008). Hope in Action: Solution-Focused Conversations About Suicide. New York: Routledge. Freud, A. (1946). The psycho-analytic treatment of children. London: Imago. George, E., Iveson, C., Ratner, H., & Shennan, G. (2009). Briefer-A Solution Focused Practice Manual. London, UK. Gil, E. (1994). Play in family therapy. New York: Guilford Press. Gil, E. (2000). Engaging families in therapeutic play. In C. E. Beverly (Ed.), Children in therapy: Using family as a resource. New York: W.W. Norton & Co. Haslam, D. R., & Harris, S. M. (2011). Integrating play and family therapy methods: A survey of play therapists attitudes in the field. International Journal of Play Therapy, 20(2), 51-65.20 Landreth, G. L. (2012). Play therapy: the art of the relationship (3rd ed). New York: Routledge. LeBlanc, M. & Ritchie, M. (2001). A meta-analysis of play therapy outcomes. Counselling Psychology Quarterly, 14(2), 149-163. Lipchik, E. (2002). Beyond Technique In Solution-Focused Therapy. New York: Guilford Press. Lund, L. K., Zimmerman, T. S., & Haddock, S. A. (2002). The theory, structure, and techniques for the inclusion of children in family therapy: A literature review. JMFT, 28(4), 445-454. Metcalf, L. (1997). Parenting Toward Solutions. Prentice-Hall, Inc. Perkins, S., & Dolbin-MacNab, M. L. (2008). The toolbox: Using a collage to access client strengths. In C. F. Sori & L. L. Hecker (Eds), The therapist s notebook, vol 3: More homework, handouts, and activities for use in psychotherapy (pp. 187-194). New York, NY: Routledge/Taylor & Franscis Group. Pichot, T. & Smock, S (2009). Solution Focused Substance Abuse Treatment. New York: Routledge. Ratner, H., George, E. & Iveson, C. (2012). Solution Focused Brief Therapy. New York: Routledge. Schaefer, C. E., & Drewes, A. A. (2011). The therapeutic powers of play and play therapy. In C.E. Schaefer s (Eds.), Foundations of play therapy (2nd ed; pp. 15-25). New Jersey: Wiley. Schaefer, C. E., & O'Connor, K. J. (1983). Handbook of play therapy. New York: Wiley. Selekman, M. (2005). Pathways to Change. New York: Guilford Press. Selekman, M. (1997). Solution-Focused Therapy with children: Harnessing family strengths for systemic change. New York: Guilford Press. Shapiro, L. (1996). The Teens Solutions Workbook. A Brand of the Guidance Group. Sori, C. F. (2006). Engaging children in family therapy: Creative approaches to integrating Ray, D., & Bratton, S. (2010). What the research shows about play therapy: Twenty-first century update. In J. Baggerly, D. Ray, & S. Bratton (Eds), Child-centered play therapy research: The evidence base for effective practice (pp. 3-33). New Jersey: Wiley & Sons. VanFleet, R., Ryan, S.D., & Smith, S. (2005). A critical review of filial therapy interventions. In L. Reddy & C. E. Schaefer (Eds.), Empirically-based play interventions for children. Washington, DC: American Psychological Association. Willis, A. B., Walters, L. H., & Crane, D. R. (in press). Assessing play-based activities, child talk, and single session outcome in family therapy with young children. Journal of Marital and Family Therapy.