Latest / Play Therapy Podcast: A Master-Class in Child-Centered Play Therapy / 429 | "All We Do Is Play": When an Anxious Child Wants to Quit Therapy

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429 | "All We Do Is Play": When an Anxious Child Wants to Quit Therapy · Play Therapy Podcast: A Master-Class in Child-Centered Play Therapy

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  You're listening to the Play Therapy Podcast with Dr. Brenna Hicks,
• 0:04
  your source for centered and focused play therapy coaching.
• 0:08
  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 Podcast where you get
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  a master class in child-centered play therapy
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  and practical support and application for your
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  work with children and their families.
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  In today's episode,
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  we are
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  talking through a question that Megan submitted from DC.
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  And this is about an 11-year-old with social anxiety.
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  So I think this is going to be really helpful for us.
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  Anxiety as a whole is probably the most pervasive issue that's
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  walking into our playrooms in the last 5 or so years.
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  But obviously there are different types of anxiety,
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  and the social aspect,
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  I think,
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  has gotten a lot worse.
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  We're seeing a lot of increase in social anxiety coming in.
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  And I have all kinds of theories on that.
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  The number one being screen use,
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  but we'll save that for another day.
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  So,
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  let me read parts of Megan's email and then we'll talk about this together.
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  I have an 11-year-old who I've been seeing for 7 sessions,
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  challenges with anxiety,
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  especially socially,
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  diagnosis of ADHD that they received from school,
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  and their parents have concerns about autism.
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  In session,
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  they have been quiet or silent in the sessions,
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  used the sand tray,
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  building things in the sand,
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  and then using sand tools.
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  I've noticed that they can be perfectionistic.
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  They often make things,
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  but
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  sometimes they will continue to work on it until it's the way they want
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  or how they like it.
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  And then sometimes this is never accomplished and they destroy it.
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  Not surprised there.
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  I'm often tracking behavior and reflecting emotion or content.
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  In this past session,
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  parent indicated that they wanted to talk to me.
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  When I reached out,
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  they reported that the client expressed they feel therapy is a waste of time.
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  All we do is play,
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  and that all I do in sessions is write notes.
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  I was wondering how you broach this sort of thing.
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  The child has not expressed anything in sessions,
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  but because they haven't been verbal and they have a flat affect,
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  it's hard for me to gauge how the tracking and reflections are landing.
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  What would you do?
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  Would you continue the sessions without bringing the topic up?
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  I have a feeling this is the answer because it would be more
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  directive to say to the child that the parent brought up whatever.
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  I reassured the parent this appears to be consistent with resistance,
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  but I was curious if there's something else that I'm missing.
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  All right.
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  So,
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  Megan,
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  it sounds like you're pretty on track with this,
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  but I'll unpack it just for the sake of discussion and,
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  and
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  making sure everyone understands.
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  So when we
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  have a child that comes in with a lot of anxiety,
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  we're going to
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  prepare ourselves,
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  not necessarily predict or presume because those are dangerous,
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  but we want to prepare ourselves for
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  the likelihood
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  that an anxious child is going to have higher
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  levels of resistance than almost any other presenting concern.
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  We also prepare ourselves that they are much slower to warm up,
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  slower to build relationship,
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  slower to engage,
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  slowing to move into work phase,
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  because
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  it's
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  the world is overwhelming,
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  the world is scary,
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  the world is too much to manage,
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  and then you throw therapy on top of it.
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  And they're already in a fragile state,
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  they're already in a compromised state,
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  and then therapy just compounds and it's like,
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  oh my gosh,
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  I,
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  I wasn't doing well before therapy and now therapy is making everything worse.
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  So confronting fears and worries and anxieties and all that,
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  that's rough.
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  And especially for an already anxious child,
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  it seems absolutely devastating.
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  So
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  we can understand that 7 sessions in,
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  this child is going to
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  be
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  likely highly resistant
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  as well as avoidant,
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  as well as
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  doing everything they can to not have to face their junk.
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  So that's a very helpful place to begin.
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  When we know we're working with an anxious child,
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  we can kind of prepare ourselves for those scenarios.
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  Then when you see perfectionistic play.
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  Oh,
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  interesting.
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  OK,
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  not a surprise because a lot of anxious kids,
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  it's self-imposed perfectionism that creates anxiety.
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  So
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  we can see that.
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  However,
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  we know that when a child tends to be perfectionistic,
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  They also are probably going to have low self-esteem.
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  And what are the two parallel tracks that we see very regularly?
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  Fun pop quiz.
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  What,
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  actually,
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  OK,
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  here,
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  this is a two-part answer,
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  y'all.
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  Let's do like a double pop quiz.
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  This is gonna be fantastic.
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  OK,
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  so,
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  when we have an anxious kid in the playroom,
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  We are likely to see what other
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  theme or symbolic play emerge.
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  So you have anxious kid,
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  what's very common behavior that's going to come up.
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  I know my coaching people are screaming at me,
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  power and control.
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  OK.
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  And then when we have a highly anxious kid,
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  we know one of the other comorbid issues,
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  root causes that they're also going to have to work through is what?
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  Low self-esteem,
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  yes,
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  thank you.
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  All right,
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  so we know
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  anxious kid
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  almost always means power and control
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  and low self-esteem.
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  Put those three
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  strands together in a braid,
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  and you have a kid exactly like you're describing,
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  Megan,
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  because perfectionistic.
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  Anxious kids operate in imperatives.
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  I have to,
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  I can't,
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  I must,
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  I won't.
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  It needs to.
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  OK,
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  so there's this language
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  mentally
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  and verbally
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  that swirls
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  that
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  mandates things,
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  forces things.
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  It's agenda
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  So this has to be perfect.
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  I can't
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  stop until it's exactly how I want it.
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  This needs to be
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  stacked 47 high,
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  whatever.
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  OK,
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  so we can see the drive behind that kind of behavior.
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  And so what you're seeing is,
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  you said your client will continue to work on it until
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  it's the way they want it or how they like it.
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  OK,
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  we could easily
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  see that
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  as
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  presenting as
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  competence work,
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  perseverance.
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  It'd be easy for us to say,
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  oh,
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  this kid just perseveres and,
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  and,
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  you know,
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  continues to work on
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  competence.
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  Well,
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  yes,
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  and
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  It's their way
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  of dealing with the perfectionistic tendencies that they have.
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  So it means to an end.
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  I'm trying to avoid
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  failing.
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  It's not really.
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  I'm going to keep doing,
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  I'm going to keep doing this because I just really feel
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  like I'm going to prove that I can do this.
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  We're not there yet,
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  so it's easy to see that as kind of a self-esteem build
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  in these early days.
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  Not really.
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  It's more means to an end.
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  I do not want to fail.
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  I can't handle it if I fail.
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  And therefore,
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  when it does not work out how they won,
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  they destroy it.
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  Why?
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  I can't handle the vulnerability.
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  I can't handle the failure.
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  I can't handle the low self-esteem.
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  I can't handle the anxiety.
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  So if I just demolish it and pretend that it never even happened,
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  I might have a chance of moving on.
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  So that all aligns,
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  all makes sense with the kind of child that you're describing,
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  Megan.
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  And so,
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  parent reaches out and says,
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  the client expressed that they feel therapy is a waste of time and
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  all we do is play and all you do is write notes.
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  All right.
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  This child is
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  11.
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  Does not have abstract reasoning yet.
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  Is not fully cognitive yet,
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  not fully verbal yet.
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  So we have a couple of options.
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  This is actually the parent's agenda
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  being presented as
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  the child's dialogue.
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  I'm not saying the parent completely made it up.
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  I'm not saying they just invented what the child said,
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  but
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  often what will happen is
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  there'll be a conversation between child and parent,
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  and the parent has an agenda.
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  You need to talk through stuff with your therapist.
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  You need to work through your anxiety with the therapist.
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  All you're doing is playing.
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  Why aren't you talking?
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  And,
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  and then the conclusion that's drawn is
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  the kid says that all they do is play and it's not helping.
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  Well,
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  that's agenda driven,
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  and sometimes that comes from the parent.
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  The other option is
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  the parent is questioning the child.
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  I guess there are 3
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  potentials here.
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  The second one is
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  the parent's questioning the child and the child doesn't know what to say.
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  Understandably,
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  they're not verbal,
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  they're not cognitive,
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  they're not rational.
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  They're 11.
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  So
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  when faced with a question of
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  how do you feel like therapy is helping you and what,
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  what are you working on with your anxiety and,
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  and how is this making things better for you,
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  what's the kid going to say other than
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  I don't know.
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  I don't really think it's helping.
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  We just play and like she just takes notes and like she doesn't ask me anything,
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  so I don't know.
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  So that's the 2nd option.
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  3rd option is,
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  The kid
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  absolutely does not want to come.
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  Avoiding,
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  resisting.
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  This is way too much,
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  too overwhelming.
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  I just,
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  I just can't.
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  So.
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  Mom,
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  this isn't even helping.
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  I don't even wanna go.
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  All we do is play.
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  We're not addressing my anxiety at all.
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  It's justified refusal to go.
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  I'm gonna give you all kinds of really valid reasons
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  why you should never make me do this again.
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  Also consistent with anxious behavior because they try to
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  avoid the things that make them more anxious.
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  So those are the three options as I see them for why that conversation took place.
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  And then the final question of this,
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  Megan,
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  yes,
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  I agree with you.
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  You would not bring it up.
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  You reassure the parents that it's normal.
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  You reassure the parents that it is avoidance and resistance
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  and a very standard part of the process.
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  You help them understand how much anxiety impacts the work
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  and how much it's taking out of this kid
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  to get to a point where they're ready,
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  willing,
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  and able to dive into their junk.
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  And
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  you absolutely would not bring that up with the child
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  because not only does that
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  put pressure on the child,
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  it also
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  makes the child question if you maybe have an allegiance with mom or dad
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  because like,
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  oh,
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  they come and talk to you and you have conversations when I'm not around.
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  We don't ever want to fracture trust,
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  so we have to be careful of that
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  and
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  you have to trust the process and trust that this kid is exactly where,
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  I mean,
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  this is session 7.
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  If we look at the timeline and the stages and phases,
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  we would overlay those three things and we would go,
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  oh yeah,
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  very clearly resistance.
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  So we accept this as this child's necessary work.
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  This is the junk that they have to work
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  through before they can get to their deeper junk,
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  and it's not easy.
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  It's scary actually,
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  and it's hard and it's deep
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  and it's heavy,
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  and it's all the stuff that anxious kids certainly do not.
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  I mean,
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  no kid wants to deal with it,
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  but anxious kids,
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  it's even worse.
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  So understandably,
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  this kid's like,
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  yeah,
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  I don't,
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  I don't want anything to do with this.
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  And so we have to trust the child,
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  trust the process,
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  trust the model,
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  and we have to be patient because it's at the child's pace.
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  Any other intervention
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  is going to force something on a child.
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  That's why CCPT is so effective for anxiety,
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  because
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  when the child is able to do it,
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  they do it,
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  but it's never forced.
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  It's never rushed.
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  We don't ever hurry the pace
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  and put demands because that makes an anxious kid more anxious.
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  However,
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  on the flip side of that,
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  we don't let a child avoid
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  their work
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  because a lot of people in anxious kids' lives.
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  Step around on eggshells and they kowtow and they're like,
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  OK,
• 11:19
  if you don't want to do that,
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  that,
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  OK,
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  you don't have to do that.
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  OK,
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  we,
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  we just won't go.
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  OK,
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  we'll just stay home.
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  All right,
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  we'll we,
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  because they're worried about the explosion or
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  the blow up or whatever's going to ensue
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  because of the anxiety.
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  So everyone in the child's world reinforces
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  the anxiety by letting them avoid anxious
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  scenarios.
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  So we're not going to force or push,
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  but we're also not going to accommodate the avoidance.
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  Kids still gonna come,
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  kids still gonna do it when they're ready,
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  willing and able to do it.
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  So they can't just walk away and say,
• 11:54
  yeah,
• 11:54
  I don't want to do this whole therapy thing.
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  But we're certainly not going to have any agenda
• 11:58
  or timeline in mind for how it unfolds.
• 12:02
  All right,
• 12:02
  Megan,
• 12:03
  thank you so much for the question and
• 12:04
  for those of you that have submitted questions,
• 12:07
  I'm,
• 12:07
  I'm almost caught up.
• 12:08
  So I know some of you have been waiting a little bit.
• 12:10
  I've been working through them and so it may not be
• 12:13
  a super long wait for y'all to get your questions answered on an episode.
• 12:16
  Brenna at the kidcounselor.com is how you can reach out.
• 12:20
  If you ever want to just say hello,
• 12:21
  I'm happy to respond.
• 12:22
  I literally read every single email.
• 12:25
  So here,
• 12:25
  let me tell you a really funny story.
• 12:26
  Laurie,
• 12:26
  if you're listening,
• 12:28
  Yeah,
• 12:28
  I'm sure you are cause you're on 320 of the podcast.
• 12:30
  So you're gonna hear this a while from now.
• 12:32
  But
• 12:33
  someone
• 12:34
  bought
• 12:35
  Parent Companion for play therapy,
• 12:37
  and we always send like a confirmation email of shipping.
• 12:40
  So when you order books,
• 12:42
  we send you an email that says,
• 12:43
  hey,
• 12:43
  your books have been shipped,
• 12:44
  whatever.
• 12:45
  And so she responded and actually goes to Eric.
• 12:47
  So she said,
• 12:48
  Hey,
• 12:49
  I'm so excited.
• 12:49
  I can't wait to get the books,
• 12:50
  whatever.
• 12:51
  And then she said,
• 12:51
  Hey,
• 12:52
  if you want to pass this on to Brenna,
• 12:53
  let her know that I'm on 320 of the podcast.
• 12:56
  I've been listening in order.
• 12:57
  So he forwarded me the email
• 12:59
  and I wrote back to her
• 13:01
  and I said,
• 13:01
  Hey,
• 13:01
  Eric,
• 13:02
  let me know that you made it to 320.
• 13:04
  Congrats.
• 13:05
  That's a lot of listening and you know,
• 13:06
  whatever.
• 13:07
  And then she wrote back and was like,
• 13:08
  Oh my gosh,
• 13:09
  like I can't believe it.
• 13:10
  And she was like so excited to hear from me.
• 13:12
  So the moral of that story is,
• 13:13
  I promise I read every email.
• 13:14
  Like they don't get filtered.
• 13:16
  I,
• 13:16
  I don't get only like a handful to respond to.
• 13:18
  I promise it's me and only me.
• 13:20
  I actually care about hearing from you all.
• 13:23
  I actually want to know your stories and your
• 13:25
  challenges and your wins and all those things.
• 13:26
  So,
• 13:27
  you're more than welcome to submit an email that has a question for the podcast,
• 13:31
  but you're also more than welcome to just like
• 13:33
  share what's on your hearts and your minds and,
• 13:35
  and let me know what's going on in your world.
• 13:37
  I love to hear that too.
• 13:38
  So,
• 13:39
  Point is,
• 13:40
  you can just send me an email for whatever reason you want.
• 13:43
  All right,
• 13:43
  I love y'all.
• 13:44
  We'll talk again soon.
• 13:45
  Bye.
• 13:46
  Thank you for listening to the Play Therapy Podcast with Dr. Brenna Hicks.
• 13:50
  For more episodes and resources,
• 13:52
  please go to www.playtherapypodcast.com.