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S3E15 - How Medical Trauma Impacts Power and Behavior in Kids · Play Therapy Parenting: Real Parenting Questions Answered by a Child Therapist

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  You're listening to the Play Therapy Parenting Podcast
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  with Dr. Brenna Hicks.
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  Hi,
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  I'm Dr. Brenna Hicks,
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  The Kid Counselor.
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  This is the Play Therapy Parenting Podcast
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  where I give you insight,
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  awareness,
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  and enlightenment about your parenting
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  and your relationship with your kids.
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  In today's episode,
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  I am answering a question from Sarah,
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  and this is about
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  her six year old son.
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  And some concerns that they have,
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  not really sure how to handle it.
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  And so I will read parts of the email and then we will process together.
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  I'm writing to you about how to address some behavioral
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  issues that we are having with our 6-year-old son.
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  He was diagnosed with an unexpected medical condition
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  which requires biweekly infusions when he was just a year old.
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  While he is very cooperative for his infusions,
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  it took us a long time to get here,
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  and I'm afraid he has some trauma that caused some of these behaviors.
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  Certain sensations bother him,
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  and he gets very emotional,
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  either crying or mad.
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  He will get upset if I cut his toenails and or fingernails.
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  He wants to run them underwater afterwards.
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  He doesn't like the way socks feel.
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  He has a meltdown when he has to wear them.
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  I've tried turning them inside out so the seams don't irritate him.
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  I've tried buying special socks.
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  Nothing seems to help.
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  We've spent 20 minutes trying to get socks and shoes on in some cases.
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  This has been going on for more than a year.
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  I do pick my battles and let him wear Crocs most days,
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  but on days it's a necessity such as soccer games and field trips,
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  this becomes a struggle.
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  Before socks,
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  he would get extremely irritated by the way his underwear felt.
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  This didn't last as long,
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  and the two issues never happened simultaneously.
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  He will not stay seated at the dinner table.
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  It's typically me,
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  my husband,
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  my older son,
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  and my 6-year-old at the table.
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  He gets up through the meal to run around the living room or try to play with toys.
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  He likes to tie up his toys with Scotch tape or with string.
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  I'm afraid this comes from him being restrained for his
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  infusions about the age of 1 until he was 4.
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  This is something that we not only ignore,
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  but we have helped him with in the hopes that
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  he would play through it and forget about it.
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  Our play therapist recommended this approach about a year ago,
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  but the behavior still persists.
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  He still wets the bed almost every night.
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  We've struggled with severe constipation on
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  two occasions now because he withholds.
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  He says mean things to get attention.
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  For instance,
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  if I take his toys as a punishment,
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  he says,
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  that's OK if you take my toys,
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  you can't take away outside.
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  Or he says,
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  I hate you with a happy tone.
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  We've all heard that,
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  right?
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  I hate you.
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  It's not funny,
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  but it is because it's like a universal behavior for children.
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  He's now in kindergarten and getting in trouble frequently at school for
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  not keeping his hands to himself and for saying hurtful things.
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  I'm afraid that the other kids are taking notice
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  of this now and distancing themselves from him,
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  which may cause other issues with the social development.
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  We did play therapy,
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  which is where I learned of your podcast for 6 months.
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  Even though I don't feel like I got a lot of insight into what was going on,
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  I did feel like it helped with the behavior issues that we had.
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  Here we are a year later,
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  and some of the same behavior is resurfacing,
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  but I'm even more concerned now that he's older and in school.
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  All right.
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  So,
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  Sarah,
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  thank you so much for the email.
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  Thank you for presenting this.
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  This is really interesting because
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  the episode on kids only have control over a handful of things
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  is so appropriate here because every single thing that you're describing is
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  related to power and control.
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  So,
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  I will weave this together
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  and hopefully that will give you some insight
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  into how you can respond.
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  OK,
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  so this is clearly a multi-layered scenario here.
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  First and foremost,
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  he's
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  a sensitive child.
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  There are children who are predisposed
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  to be
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  more emotional and more sensitive.
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  So I think that has to be an understood
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  component of this.
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  children are wired differently.
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  That's why there's nature and nurture.
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  So,
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  he
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  was born likely
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  with
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  higher sensitivity and bigger emotions,
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  deep feeling,
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  highly sensitive child.
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  Ironically,
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  children that are not
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  deep feeling and highly sensitive typically don't end up as dysregulated
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  because
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  things don't bother them as much.
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  Kids don't impact or things don't impact or affect them as much.
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  So,
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  I often joke that the kids that are just laid back and easygoing and
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  they don't really have a care in the world,
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  they just ride waves,
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  they rarely end up in play therapy.
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  Because
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  those are kids that are naturally just more laid back and less sensitive and
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  less affected by things.
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  So we recognize that your son,
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  Sarah is more sensitive and more emotional.
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  That is going to be a factor here,
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  and that can be something that he addresses,
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  but it's certainly still going to be an undercurrent.
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  OK,
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  so as far as cutting fingernails and toenails and then running to them,
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  run them underwater afterwards,
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  I suspect
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  that
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  it's one of two things.
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  It's either
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  he feels powerless when you're cutting his fingers and toes because you have
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  to hold them and you're in charge and you have a sharp instrument,
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  and with medical trauma,
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  I suspect that there's probably an anchored memory there.
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  And water is soothing.
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  Water is cool.
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  Water is something that can kind of immerse the senses in a different way.
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  So that sounds like a control-based coping strategy.
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  After you cut my fingernails and toenails,
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  I have to run them underwater.
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  That is soothing.
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  Understandable
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  for
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  a highly sensitive.
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  Emotional
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  kid with medical trauma.
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  Socks and underwear,
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  that is one of the most consistent
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  issues that parents bring up
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  when you have a highly sensitive child
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  with big emotions.
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  It's not really the texture of the sock.
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  It's not really how the underwear felt.
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  It's not really whether they're comfortable or have a seam
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  or are pokey or prickly or whatever.
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  It's control.
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  And it's high sensitivity
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  for tactile sensation.
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  He's a sensitive kid,
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  so another kid would put a sock on and forget about it.
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  Highly sensitive kids
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  with big emotions,
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  they feel things more deeply.
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  And I've seen child after child after child
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  where a parent has said,
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  I think that
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  there's a sensory sensory issue here.
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  I think we need to do some kind of therapy for sensory stuff.
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  I think that this child is overstimulated by things.
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  In CCPT,
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  they reduce their anxiety,
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  they reduce their need for control,
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  and they no longer care about socks and underwear.
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  So that will naturally sort itself out
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  as we reduce anxiety and need for control.
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  Not staying seated at the dinner time.
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  He has the ability to hop up.
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  So there's another control grab.
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  The expectation is everyone's going to sit at the table,
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  but he can hop himself out of his chair and go run around.
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  And so
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  over a few things,
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  children have control.
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  This is one of them.
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  He
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  ties his toys up with tape or yarn.
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  OK,
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  I do actually agree with you that this is playing out
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  memories,
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  anchored memories and medical trauma,
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  and the fact that he's still doing it.
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  It means that he hasn't
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  sorted it out yet.
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  Kids will continue to play out the same thing
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  until they've largely resolved the issue.
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  And how do they largely resolve the issue?
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  Well,
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  obviously with the help of a play therapist,
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  it's going to be resolved more effectively and efficiently
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  because there's therapeutic dialogue and engagement while a
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  child is playing something like this out.
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  But even playing
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  on his own.
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  He is trying to desensitize himself from the emotions.
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  He is trying to rewrite the narrative.
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  He's trying to change the story.
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  He's trying to put himself in a position of power
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  where in the real world,
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  he actually felt very powerless.
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  So there's a process that children go through when they play out things like this,
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  and obviously with the presence and relationship and environment
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  that CCPT affords,
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  it's going to be more helpful.
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  But if he's still doing this,
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  then there's still a need there.
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  And there's nothing inherently problematic about that.
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  That is him continuing to try to make sense
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  of his experiences and his feelings surrounding those experiences.
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  Wetting the bed and constipation,
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  there's more toileting control.
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  So
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  that's also very consistent with children
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  that are grasping for power.
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  Toileting is another component of that,
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  and then saying mean things.
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  When you
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  quote,
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  take toys away,
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  and I'm,
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  I'm actually going to challenge you,
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  Sarah,
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  I'm going to challenge all of us actually,
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  be really intentional with your words.
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  Because
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  if you provided a limit with choices in that scenario,
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  and I'm not sure whether you did,
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  but if,
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  if CCPT is a part of your parenting practice,
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  it would have been
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  a limit and choices.
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  So,
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  You really would like to
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  continue to play with your toys,
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  but it's time for dinner.
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  You go through that 3 times,
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  and he still chooses to keep playing with his toys.
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  So then we move to ultimate limit.
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  If you choose to come to the dinner table right now,
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  you choose to play with your toys later tonight.
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  But if you choose to not come to the dinner table right now,
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  you choose not to have toys for the rest of the night.
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  Which do you choose?
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  That is very clearly a choice.
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  And therefore,
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  if he chose not to come to the dinner table right away,
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  then he chose not to have his toys.
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  So we need to be very intentional with our language around this
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  because you said if I take his toys away as a punishment.
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  We never need to punish our kids.
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  We need to enforce choices that were made.
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  And we would have chosen for him to keep his toys.
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  I've said that to my son so many times.
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  Baby,
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  I would have chosen for you to have
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  whatever
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  you chose not to.
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  So when he chooses not to have his toys,
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  you can say he chose not to have his toys,
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  not I took them away as a punishment.
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  That's a very important distinction
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  because we would always choose for our children to
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  have the things that they want and need,
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  but sometimes they choose otherwise,
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  and that is how they develop self-control.
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  And
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  so what happens in that scenario is he feels powerless.
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  He chose not to have his toys.
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  He really wants his toys,
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  and now he has no control over that.
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  So he's going to grasp at power and control.
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  So he's going to act as if it doesn't bother him at all.
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  He's going to present as completely unfazed,
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  completely content with the scenario,
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  and he's going to take some power back.
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  So
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  that's OK if you take my choice.
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  I don't care one bit.
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  There's the indifference,
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  even though we know that that's masking,
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  and you can't take away outside.
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  That's control.
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  Watch this.
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  You just took control over me,
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  but I'm going to get you back because you
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  can't control the fact that outside still exists.
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  It's another power grab.
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  Similarly,
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  I hate you.
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  It is to have power and control,
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  because when you feel powerless,
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  you're vulnerable.
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  But when you behave in aggressive ways or you are verbally aggressive.
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  You feel powerful again.
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  So it's another level of masking.
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  So,
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  hopefully,
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  Sarah,
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  this is all starting to make sense to you.
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  When you have a child that has gone through
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  medical diagnoses,
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  medical procedures,
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  medical traumas,
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  twice a month infusions,
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  you know,
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  for a 6-year-old,
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  most
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  adults in their 60s have not gone through
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  the things that your 6-year-old has gone through.
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  And when you have a child that has been put through the wringer with stuff like this.
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  They feel even less in control than
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  kids that have not gone through stuff like this.
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  Every kid feels powerless,
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  understandably,
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  and we just talked about it.
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  They only have control over 5 things in their lives.
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  So of course they feel powerless.
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  Universally kids do.
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  But then you have these extra layers of complications with the medical.
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  Now he feels that he has no control and he is always at the mercy of someone else.
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  I'm always at the mercy of the circumstance.
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  I'm always at the mercy of the person in control and authority.
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  I'm always at the mercy of the diagnosis that I have.
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  I'm at the mercy of requiring these infusions.
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  You can see how that would build and build and build,
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  and he would just say,
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  that's it.
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  I'm going to take power and control wherever I can take it.
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  This is really common with kids
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  that deal with diagnoses that other children don't face.
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  This is true of learning disabilities.
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  This is true of medical complications.
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  This is true of developmental delays or issues.
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  Anything like that,
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  that their peers do not experience.
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  They take power to the hilt.
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  Because
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  it's even worse for them.
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  So
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  I would actually encourage you,
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  if you're seeing some of this stuff continue,
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  I would revisit child-centered play therapy.
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  And if you want to email me and ask for recommendations,
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  I have a community of CCPTs that I've personally trained,
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  and I can see if there are any close to you and put you in touch with those who
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  are very highly knowledgeable about child-centered play therapy.
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  But I really do believe that
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  this
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  is something that he can work through,
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  and it seems as though there's still a lot that he's trying to process.
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  And so child-centered play therapy would probably be helpful,
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  at least for refreshers and boosters.
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  Once a child has gone through a round of play therapy,
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  usually if they go back,
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  it's a much shorter
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  group of sessions
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  because it's just a reminder of what they've already learned.
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  And so,
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  I would highly encourage you to reconsider that,
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  especially since
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  there are still some struggles and there are issues at school.
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  We want to try to get ahead of that.
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  Proactivity is always more helpful than reactivity when it comes to therapy.
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  So Sarah,
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  thank you so much for the email.
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  I appreciate it.
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  And
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  we all are dealing with kids that want control.
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  At any age,
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  we are wired
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  to try to have control,
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  and when we don't have it,
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  we don't like it.
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  And that will really help provide insight into
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  children's behaviors and therefore our responses as well.
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  I love you all.
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  Hope you have a great week.
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  We'll talk again soon.
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  Bye.
• 14:24
  Thank you for listening to
• 14:26
  the Play Therapy Parenting Podcast with Dr. Brenna Hicks.
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  For more episodes and just subscribe to our newsletter,
• 14:33
  please go to www.playtherapyparenting.com.