By: Nagia E. Moharram, TMWF Communications
At TMWF social services, Jameela Tifla1 provides play therapy to children, adolescents, and adults. Ms. Tifla, a Texas Licensed Professional Counselor (LPC), who specializes in play therapy, explains the effectiveness of her counseling services.
With children, ages 3 to 12 years, Ms. Tifla uses child-centered play therapy. She explains, “[For children] play therapy is what talk therapy is to adults. Play is their natural language …[and is] innate to them…. [Through play] they learn about themselves …[and] about the world…[and] make sense of the world. It’s just the most natural process for them.” During the play therapy sessions, toys become a child’s words and play becomes the child’s language.
The toys in her playroom can be found in any home, but Ms. Tifla specifically choses them for their therapeutic value. The toys are of different categories: aggression (a sword, hand cuffs, a dart gun, a drum), nurture (a baby doll, stuffed animals), pretend (dolls, a doll-house, kitchen, puppet theater), mastery (puzzles, blocks, cards), dress-up (clothes), expression (art, musical instruments), and so on. The different categories allow children to express themselves in different ways.
The child begins by exploring the playroom, but eventually chooses certain toys; slowly a theme emerges in his play, which depicts what he is experiencing in his life.2 Ms. Tifla does not correct the child, nor direct his play, but she trusts that that the child will take the therapist where the child needs to go, in terms of their processing their trauma.
One key component of play therapy is the genuine relationship between the therapist and the child, where the child feels comfortable enough to trust the therapist. The therapist is supportive, non-judgmental, fully present, and supports the child by reflecting on the child’s feelings. For example, the child might bang on the ground the aggression toy sword. Ms. Tifla’s reflective response might be, “Johnny, you are really angry. You feel like hitting that on the ground.” She reflects by providing words to the feelings exhibited in his actions.
The therapist’s reflection does two things. First, it validates the child’s feelings; second, the therapist is giving the child the words to express those feelings in an appropriate way. Children may not have the cognitive ability to express themselves, especially when they have experienced trauma.
Although the play in the playroom is unstructured, the therapist does impose some limits. If a child is trying to hurt himself or the therapist, or tries to break something, Ms. Tifla uses what is called, “therapeutic limit setting.”
The acronym for those limits is, ACT, where:
- “A” stands for “Acknowledging the feeling”;
- “C” stands for “Communicate what the limit is”; and
- “T” stands for “Target the alternative.”
Using the previous example, if “Johnny” were to use the sword to try to hurt Ms. Tifla, she would say, “You are so angry at me that you are wanting to hurt me, but I am not for hitting. You can pretend that inflatable Bobo Doll (a large inflatable doll in the shape of a punching bag) is me, and you can hit that instead.” By using the therapeutic limit setting, Ms. Tifla has, “A,” acknowledged the child’s feelings (anger, in this case); “C,” communicated the limit on his actions that it is not ok to hurt someone (“I am not for hurting”); and “T,” targeted an alternative way of for the child to express his feelings that is not harmful (letting his anger find expression in the punching of an inflatable toy).
Using ACT therapeutic limit setting highlights to the child that all feelings are ok, but all behaviors are not. Such limits help children distinguish between healthy ways of coping and expressing their anger in unhealthy ways. Ms. Tifla emphasizes, “We don’t want to keep the child from expressing [his] feelings, …whatever the feeling is, those feelings are ok and it’s ok to express them, but it’s important for the child to learn how to express them in a safe way, in a safe place, without hurting himself, hurting someone else, or breaking something. Here [in the playroom] he is allowed to feel, but limits are put in place…[and he is given] an alternative way to express himself.”
The entire playroom is available for that unstructured play which gives the child a sense of having control over what he wants to do and how he wants to do it, within therapeutic limits. The child has control inside the playroom that he may not have in his life outside the playroom. If, for example, there occurred a traumatic catastrophe, such as a flood, where the child might have lost his home, he would have had no control over that event. The playroom offers the child a place to regain some control over his life, which is therapeutically empowering.
Eventually, what the child learns in the playroom, he applies outside the playroom. For example, the mastery category of toys, which allow children to win a game, build something, or become competent at something, gives the child a sense of having control. The mastery and achievement they experience gradually builds their self-esteem. Ms. Tifla might reflect that achievement of mastery, “You made that, and you’re so proud of yourself.” She explains, “Being able to build that self-esteem through these activities, helps transfer that same built up self-esteem outside of the playroom…. Every time I am reflecting, I am building up the child’s self-esteem.”
Ms. Tifla emphasizes that play therapy is a slow process. It takes time for a child to build enough trust in the therapist to play out a meaningful life event and allow himself to expose his feelings in the playroom. There isn’t one pivotal point were the child has instantly healed. Rather, the child has various contemplative experiences through his play guided by the therapist’s reflections. Every child is different and they each go through various stages in the playroom. Multiple play therapy sessions are needed for the child’s realizations to add up to healing and the success of the therapy. Ms. Tifla urges parents to bring in their child on a consistent basis, because consistency is what allows for better outcomes.
Sand Tray Therapy
With clients that are older children, adolescents, or adults, Ms. Tifla uses another form of play therapy, called sand tray therapy. Because play therapy is very much about developmentally appropriate practices, sand tray therapy is used with her older age clients who can benefit from the more structured form of therapy. Like the playroom, the sand tray toys also have categories. In sand tray therapy, the therapist will give a prompt. For example, Ms. Tifla might ask the client to create a scene of what he’s feeling that day, or a scene of his current life. Once her client has created the scene, he and Ms. Tifla process it together. The client will talk about why he picked what he picked and what it means to him. Ms. Tifla explains, “A lot of times, when doing the sand tray, it’s like looking at yourself or your life outside of yourself. It’s almost like an out of body experience. It makes the experience really real for them. ‘This is my life; this is how it is; or this is how I want it to be.’”
Some clients on their own will create two sections in the sand tray: “This is how I want my life to be, and this is what my life is right now.” Ms. Tifla might ask the client to use the sand tray to make a day in his future, to encourage goal setting. The therapist processes the scene with the client to help him find ways to cope with the experience in the scene he has created. For example, if the client has created a bullying scene depicting him surrounded by several other children, the therapist might ask, “Well, what do you think you need right now to feel safe?” He might pick out a play figure that he feels will make him feel safe, perhaps a figure that symbolizes his teacher. And then he might say, “If the teacher were next to me, I would feel safe.” In the moment of processing, the client is coming up with a resolution, “This is what I can do,” which provides him with a sense of control, of knowing what to do next time.
Through the processing of the sand tray scenario, the client becomes empowered to express himself and has his feelings validated (he was scared); also he feels safe by finding a resolution and having a plan for next time [seek out the teacher]. Ms. Tifla explains, “Even being able to feel a feeling and express it, is half the battle. And someone listening, not expressing, just listening and validating that feeling is so therapeutic.”
She explains that children have to rely on their adult care-givers at home, siblings, classmates, teachers, or counselors to validate their feelings. But if their life’s circumstances do not provide them with anyone other than their play therapist to listen to their fears and concerns, then their relationship with the therapist becomes very important. The sand tray is a very powerful medium in therapy to allow the client to work things out.
Child Parent Relationship Training
With children under the age of three, Ms. Tifla uses Child Parent Relationship Training, (CPRT) which is based on a ten-session curriculum. She explains, “CPRT is basically coaching parents in some very basic play therapy skills that I use in the playroom, to allow them to be agents of change in their children’s lives.” Parents are coached in basic play therapy skills and helped to choose specific, simple, affordable toys (that can be bought at the dollar store) to create their own toy box at home.
Parents are asked to have a 30-minute play session once a week with their child, during which they are required to be fully present with their child. Being fully present means that any distractions are put away. Cell phones must be put away; TV’s must be turned off; and any other children must be looked after by the other parent or another care-giver. The play session must be a specific designated time for one parent to be alone with the child in play therapy for 30 minutes.
Parents are coached in basic reflection skills. Ms. Tifla tells parents to allow children to play without intervention or correction, while keeping the ACT therapeutic limits in place. Parents find it difficult initially, but they slowly get used to letting the child be. Ms. Tifla suggests, “Play dumb. If your child says, ‘Can you open this for me?’ or ‘Can you do this for me?’ Reflect, ‘Oh you’d like for me to help you.’ If it truly is a hard thing to do, say, ‘Let’s figure this out together.’” She continues, “And if it’s hard to open, twist it open a tiny bit, and ‘hmm why don’t you try this again.’ And then the child might open it by themselves, and then the child might say, ‘I did it!’” She explains to parents that by allowing the child to figure things out, the parent is helping their child with mastery, which strengthens the child’s self-esteem.
The two things CPRT hopes to achieve is strengthening the parent child bond and helping the parent understand the child in a different and better light. The therapeutic limit setting, ACT, helps the process along. Eventually, the 30-minute play session and the ACT limits transition into their daily lives as common behavior. Positive changes slowly emerge. CPRT works when the parent is stable enough to be the child’s anchor and agent of change. If parents aren’t stable, and do not feel that they can be fully present, Ms. Tifla encourages them to take care of themselves first, acknowledging the importance of parents to take care of their own needs. However, Ms. Tifla continues to work with the child and allows the parents to participate in whatever capacity they can offer. “I work with them where they are.”
1 Name changed for privacy
2 The male pronoun “he/his” is used generically only for clarity in the text to distinguish between the therapist, who is female, and her client. Ms. Tifla helps both male and female clients.