Using Creative Termination Rituals with Children and Adolescents Matthew J. Paylo, Ph.D., LPCC-S (Ohio) Victoria E. Kress, Ph.D., NCC, LPCC-S (Ohio) Michael J. Leskosky, B.A., CT Mansi Brat, M.A., LPC Katie Gamby, M.A., LPC, CWC Stephanie Sedall, B.A. Presentation Objectives Discuss the importance and relevance of termination rituals. Discuss and learn several creative termination rituals that can be utilized with children and adolescents. Personal Reflection Activity 1&
What are the goals of termination? Acknowledging and affirming the changes clients have made over the course of treatment Exploring clients thoughts and feelings about the ending of services (e.g., closure) Aiding clients in preparing for the transitions ahead (e.g., aftercare plans, need for additional support, potential triggers, a less restrictive environment) Exploring and preparing clients for areas of additional work (or future goals) The process of actually saying good-bye to clients What do we know about termination? While the significance/importance of preparing clients for termination seems to be addressed within the literature, little discussion seems to exist with specific, pragmatic ideas for providing closure, honoring the therapeutic relationship, and celebrating all the work accomplished during treatment. For most clients, termination is a difficult process. Many clients may feel loss the loss of a meaningful relationship, the loss of support, and the loss of structure within their week. A lack of processing clients thoughts and feelings about termination may also lead to increased levels of frustration and distress. Termination Rituals 2&
What are rituals? Or termination rituals? A ceremony that progresses in a specific order An activity that marks a specific time and space for an individual (e.g., conformation, bar mitzvah or bat mitzvah) A reevaluation of past events in light of the present moment A celebration where clients can tell their stories among the company of others who know and love them An acknowledgement of an achievement, a mark of development, or an entering into a new status (e.g., graduation) (Lenz, Zamarripa, & Fuentes, 2012) Why should you consider using terminations rituals with children? A deliberate, thoughtful termination experience aids in children s ability to be hopeful and future-oriented. Provides children with a sense of closure. Increases children s sense of empowerment and accomplishment. Increases their ownership of the termination experience. Careful attention to the process of termination and the use of termination rituals could aid clients in maximizing their overall treatment benefit (e.g., continuing in the gains of treatment). (Paylo, Darby, Kinch, & Kress, 2014) What does the process of termination rituals look like (generally)? Termination rituals often consist of 5 steps: 1. Initiation Overview and a general discussion of the termination activity/ ritual/ceremony 2. Preparation Outline the specifics (e.g., time, location, steps involved, the product, participants) 3. Participation Allow the child to express his or her story in a creative way; allow others to listen and react; counselor can assist in activity, aid in meaning making process, and create a safe environment 3&
What does the process look like? 4. Emancipation Counselor reiterates the themes and significant components of the clients stories, transformation, and accomplishments 5. Commemoration Certification of completion; celebration (e.g., balloons, music); letter from counselor summarizing the clients strengths and accomplishments (Lenz, Zamarripa, & Fuentes, 2012) Some examples of creative termination rituals for use with children and adolescents (Kress, Paylo, & Stargell, 2017) Aloha Lei In this activity, the Hawaiian aloha lei is used as a metaphor for saying goodbye. Explain to the client that the word aloha means hello as well as goodbye, because when something ends, a new beginning follows. Invite the client to consider that change is constant and that each new beginning will eventually come to an end. Present the client with a string and cut-out paper flowers with a hole punched through the middle. On each flower, the client is invited to write down coping skills, insights, or important counseling experiences. Other flowers may represent future goals or people who can be turned to for support. As the client places each flower on the string, he or she can share what each flower means. When finished, the counselor can take the string, tie the ends together, and place it around the client s neck as a parting gift. This activity may be expanded to include family members, who can create their own flowers for the lei. 4&
Building Blocks This activity is both physically and mentally engaging, and especially useful with younger children. At the final counseling session, lay out a set of blocks. Invite the client to build a tower. Explain that each block placed in the tower represents something learned in counseling. For example, the first block placed as the foundation might represent honesty or trust one of the basic principles of the counseling relationship. The counselor can participate as well, either by helping to place blocks as the tower grows taller, or by reminding the client of lessons learned or goals achieved. Each block represents a new skill or strength and as the tower grows, the client sees her or his accomplishments and ideally, feels empowered. As the client places the blocks, the tower may grow too tall, which is exciting and challenging for the client. Explain that it is okay if the tower eventually falls since all the pieces are there and thus they can be put back together. In other words, the client may experience some falls, but he or she has the essential foundations needed to be successful. Goodbye Letter Counselors can use a pre-formatted letter or have clients write an original letter to help them recall and integrate their memories of counseling. The letter may be written to the client from the counselor and/or, to the counselor from the client, and/or from the client to the client, or any other variation that fits the client s situation. Counselors may include or provide prompts such as, I remember a time we., or One skill I learned is, or The thing I am most taking away from counseling is Try to choose phrases or sentence starters that will help clients narrow down the most important parts of counseling, and, as with all termination activities, keep the conversation strength-based. The Survivor Tree In this activity, the client draws a tree that represents his or her strengths, capacities, and resources. Remind the client that trees are strong and perseverant, just like the client. Trees also change in different seasons, and their leaves fall off and then come back, but they are always growing up and maturing. Each branch of the tree can represent a different branch of counseling skills learned, goals achieved, identified strengths, supports garnered, etc. Clients add leaves to the branches to represent what they have learned. They may place leaves on the ground to represent problems or struggles they have eliminated or overcome. If age appropriate, the counselor might share the story of the Survivor Tree located in New York City. After enduring the September 11, 2001 terror attacks at the World Trade Center, the tree stands as a living reminder of resilience, survival and rebirth. This activity can be adapted to meet different levels of artistic ability. For example, counselors may utilize a pre-formatted tracing of a tree (readily found online); they may work with clients to draw a tree; or they may allow clients to create their own tree using different mediums if they have more advanced fine motor and artistic skills. 5&
Making a Case for Counseling A case is a box or receptacle that holds something. People also use a case to transport or take relevant items with them. In this activity, clients create a case in which they hold the important aspects of counseling that they want to take as they move forward. One of the strengths of this activity is its flexibility. The type of case can be adapted to suit the client s needs or interests. These might include a suitcase, purse, a treasure chest, a tool box, or even a toy boat. Cases can be created using simple tutorials found online, and recycled materials (e.g., cereal boxes, yogurt cups, jars) are a free, accessible medium that can be helpful for this application (see Adamson & Kress, 2011). If working with younger clients, counselors may want to prepare the case prior to meeting; older clients may enjoy building their own case. Work with clients to decide what they will fill their case with encourage them to delve into their counseling experience for memories, skills, or goals. Be creative in designing the item that will be placed in the case (e.g., tools for the toolbox; colorful pieces of paper for the treasure chest; oars or lifejackets for the boat). Review the meaning of each item before inserting it in the case. Family members can be encouraged to contribute items as well. Memory Book This activity can occur over several termination sessions. In this activity, counselors work with clients to create a memory book of their counseling experience. Counselors may help facilitate the content of the book, or allow the client to choose what he or she wishes to include. Counselors wishing to provide more structure may have pages in the book labeled or identified (e.g., skills learned, important things I am taking away from counseling, my action plan). Clients may draw images or pictures, or if older, they may write their reflections out. Clients may also complete pages in between several sessions as termination approaches. Counselors may also wish to tuck a brief goodbye note in the front cover or include a thoughtful inscription. At the final session, clients family member(s) may be invited to contribute their reflections, words of encouragement, or observations. The Big Picture In order to clearly communicate the counseling process including eventual termination with clients, counselors can keep a chart that visually tracks each session. This activity is especially useful with younger children. Invite clients to color a tiny picture or choose a sticker to place on the chart at the end of each session. During each visit, clients will then have a visual reminder of how many times they have visited, as well as how many sessions they have left. While the number of sessions may be uncertain early in counseling, as termination approaches, the counselor can highlight the anticipated final session so that the child can see that the final session is approaching. As the young client completes the chart activity, the counselor can review what was done in the session or in past sessions. At the final session, counselors may want to give the completed chart to the client so he or she can keep it as a review of counseling. 6&
Wish Upon a Star In this activity, clients reflect on their goals, hopes, and dreams for the future; it orients clients to a brighter future. Encourage clients to consider what they wish for their future selves. Discuss the ways these wishes may come true, or be realized utilize goal setting and other skills learned during counseling. Clients can write the words on the stars or draw pictures if they are younger to represent their goals, hopes, and dreams for the future. Review the content on the stars as the client places them in a constellation shape on a larger piece of paper. Clients may also elect to save the stars in an envelope instead, or they may even stick them to a space of their choosing (e.g., their ceiling, over their bed, or on a bathroom mirror). Pause, Reflect, and Commit Questions? 7&
Email addresses:! mpaylo@ysu.edu! victoriaekress@gmail.com! leskoskym@gmail.com! mansi.brat@rockets.utoledo.edu! katie.gamby@rockets.utoledo.edu! s.sedall@vikes.csuohio.edu References Kress, V. E., Paylo, M. J., & Stargell, N. (2017). Counseling children and adolescents. Upper Saddle River, NJ: Pearson. Lenz, A. S., Zamarripa, M. X., & Fuentes, S. (2012). A narrative approach for terminating therapy. Journal of Professional Counseling: Practice, Theory, Research, 32(2), 2-13. Paylo, M. J., Darby, A., Kinch, S., & Kress, V. E., (2014). Creative rituals for use with traumatized adolescents. Journal of Creativity in Mental Health, 9, 111-121. 8&