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Transcript

What’s the Backbone of Great Play & Expressive Arts Therapy? · Next Level Play Therapy: A Podcast for Play Therapy Excellence

• 0:02
  Cathi Spooner: Welcome to Next Level Play Therapy, a weekly podcast dedicated to supporting the next generation of child and adolescent therapists to provide exceptional play therapy services.
• 0:14
  Cathi Spooner: We'll explore all things play therapy to elevate your work with children and adolescents using the therapeutic powers of play.
• 0:23
  Cathi Spooner: I'll discuss practical tips and ideas.
• 0:26
  Cathi Spooner: So you can provide a transformative experience for your young clients and make a real difference in their lives.
• 0:34
  Cathi Spooner: So get ready to take your play therapy skills to the next level and make a lasting impact in the lives of children, adolescents, and families.
• 0:46
  Cathi Spooner: Good morning.
• 0:48
  Cathi Spooner: Good morning.
• 0:49
  Cathi Spooner: Good morning.
• 0:50
  Cathi Spooner: Today we're going to talk about what I consider to be the backbone of therapy, and that includes play therapy.
• 1:02
  Cathi Spooner: And, um, it's kind of foundational, that doesn't always sound so exciting, just because when you say foundational, people go wah, wah, wah.
• 1:12
  Cathi Spooner: Boring, yawn, yawn, yawn.
• 1:15
  Cathi Spooner: Um, The thing is, though, I really, really, really think that case conceptualization is something as mental health professionals, we're always needing to work on improving and growing in our skill with that because it is the backbone to really good therapy.
• 1:39
  Cathi Spooner: And in my experience in the last almost 30 years, I have seen the difference that it makes in a therapist and the quality of the services that are provided, if we really grab hold of and make it a priority to, um, get really good at our clinical case conceptualization.
• 2:05
  Cathi Spooner: I, I like to think of it as being a mental health super sleuth.
• 2:10
  Cathi Spooner: So a mental health detective, figuring out what are the roots underneath the behavior in order to, um, better understand the symptoms that are bringing our clients to our therapy offices because the symptom is dependent upon the roots.
• 2:32
  Cathi Spooner: And that's what I'm going to talk about today is really understanding what is clinical case conceptualization, some tips for making sure that you're using good clinical case conceptualization, how do you, how do you do that?
• 2:54
  Cathi Spooner: And then also a little bit about what happens if you don't.
• 3:00
  Cathi Spooner: So that's what we're going to talk about today.
• 3:02
  Cathi Spooner: If you find this helpful, please like, and share it across your social media platforms.
• 3:10
  Cathi Spooner: And if you're joining from my YouTube channel, go ahead and hit that subscribe button, so you'll be notified when, when I go live, eventually I'm going to post some videos on there.
• 3:24
  Cathi Spooner: I just haven't gotten that far yet.
• 3:26
  Cathi Spooner: Um, and you can hit that notification bell.
• 3:30
  Cathi Spooner: It'll notify you when I do go live or when I do post, uh, eventually post a video on there about Play Therapeutic Expressive Arts.
• 3:39
  Cathi Spooner: All right.
• 3:40
  Cathi Spooner: So, listen up if you have any questions, please feel free to post those.
• 3:45
  Cathi Spooner: Those of you joining me live, go ahead and post your name in the comments.
• 3:50
  Cathi Spooner: Let's see where you're from.
• 3:52
  Cathi Spooner: And let's get started.
• 3:54
  Cathi Spooner: Okay.
• 3:55
  Cathi Spooner: So first and foremost, what exactly is case conceptualization?
• 4:02
  Cathi Spooner: So case conceptualization is essentially what is going on, um, underneath the presenting symptoms and then how, how you conceptualize that.
• 4:16
  Cathi Spooner: So it's going to be based on your theory model, how you conceptualize the symptoms.
• 4:22
  Cathi Spooner: The thing is, you have to really understand what I call the roots of the symptoms in order to, um, really understand what's going on.
• 4:36
  Cathi Spooner: And so the case conceptualization, the way in which we understand and make sense of those symptoms, um, Also helps us that informs what treatment approach we're going to be using.
• 4:51
  Cathi Spooner: Um, so and essentially it's our road map.
• 4:55
  Cathi Spooner: So from our case conceptualization, we formulate a diagnosis and a treatment plan.
• 5:02
  Cathi Spooner: The way that I think about a treatment plan is that's our roadmap.
• 5:06
  Cathi Spooner: This is how we're, um, taking that case conceptualization and creating a roadmap to help us get from beginning to end.
• 5:15
  Cathi Spooner: To help us, um, get our clients all the way through to successfully completing the treatment process, which ultimately means that we've helped them to resolve the issues that are going on for them.
• 5:34
  Cathi Spooner: And sometimes, you know, sometimes like they'll come for a period of time and then we'll, we'll help them, uh, ameliorate those symptoms, get that kind of, get to a better place.
• 5:47
  Cathi Spooner: And then maybe later on down the line, they may hit some bumps in the road and they may come back to us.
• 5:52
  Cathi Spooner: And then we'll, we'll do that process again.
• 5:54
  Cathi Spooner: It'll be a little different because they'll be in a different place.
• 5:58
  Cathi Spooner: But today we're just going to really focus on new clients coming in.
• 6:03
  Cathi Spooner: And how to conceptualize those treatment symptoms that they're, that they're reporting to us.
• 6:12
  Cathi Spooner: So to do that, I want to give it a, use an example.
• 6:16
  Cathi Spooner: So I am going to share my screen.
• 6:22
  Cathi Spooner: I think I'm getting, oops, I just, dang it.
• 6:25
  Cathi Spooner: I hit the wrong one.
• 6:28
  Cathi Spooner: My tech.
• 6:29
  Cathi Spooner: There we go.
• 6:30
  Cathi Spooner: Tech savvy skills.
• 6:32
  Cathi Spooner: Alrighty.
• 6:33
  Cathi Spooner: So let me go to my PowerPoint.
• 6:41
  Cathi Spooner: Okay.
• 6:42
  Cathi Spooner: So you should be able to see this.
• 6:47
  Cathi Spooner: So case conceptualization, the way that I think about it is essentially being a mental health super sleuth.
• 6:54
  Cathi Spooner: Also known as a mental health detective.
• 6:58
  Cathi Spooner: So I love the saying roots determine fruits.
• 7:01
  Cathi Spooner: Meaning, so if we look, use the, I love a good metaphor.
• 7:05
  Cathi Spooner: Um, and so I just realized some of my other graphics are missing.
• 7:12
  Cathi Spooner: Darn it.
• 7:13
  Cathi Spooner: Um, so if we use the analogy of a tree, think about the roots of a tree and the, if you have an apple tree, the roots of that apple tree, are not going to produce apples, uh, uh, pears if it's an apple tree.
• 7:36
  Cathi Spooner: If it's an apple tree, it'll produce apples.
• 7:39
  Cathi Spooner: If it's a pear tree, it will produce pears.
• 7:42
  Cathi Spooner: If it's a walnut tree, it'll produce walnuts.
• 7:46
  Cathi Spooner: So, uh, whatever is going on below the surface, which is where the roots exist, whatever is going, going on below the surface is what we are aiming to figure out.
• 7:59
  Cathi Spooner: That's our target.
• 8:02
  Cathi Spooner: So let's take, for example, Um, emotion regulation.
• 8:07
  Cathi Spooner: Emotion dysregulation is probably one of the most common things that brings children into the play therapy, uh, treatment process.
• 8:17
  Cathi Spooner: And so if you think about emotion dysregulation, there are any number of things that can be the roots of that emotion regulation, and it can be a combination of those things.
• 8:32
  Cathi Spooner: So for example, anxiety and depression.
• 8:35
  Cathi Spooner: So when a child is anxious and overwhelmed, they could be easily dysregulated because they're afraid.
• 8:43
  Cathi Spooner: Sometimes with depression, especially in children, they're super cranky and irritable.
• 8:50
  Cathi Spooner: That is one of the symptoms of depression in children.
• 8:53
  Cathi Spooner: And often times, anxiety and depression go hand in hand.
• 8:57
  Cathi Spooner: They don't always, and it's not uncommon that they do.
• 9:01
  Cathi Spooner: So one of the things that I always make sure to look for if, um, somebody is coming in and they're saying they have anxiety, especially if I'm working with adults or parents.
• 9:12
  Cathi Spooner: Um, I'm also gonna explore the possibility of depression.
• 9:18
  Cathi Spooner: The other thing is if we have a child coming in and let's say they have undiagnosed ADHD and some executive dysfunction problems, one, uh, uh, emotion regulation, um, is part of the executive functioning process.
• 9:36
  Cathi Spooner: That's not something we really talk much about in the mental health field.
• 9:41
  Cathi Spooner: In fact, I just watched a really good, uh, one hour, uh, training with Russell Barkley.
• 9:49
  Cathi Spooner: About, uh, how emotion dysregulation, uh, emotion regulation gets left out of the ADHD diagnoses.
• 9:57
  Cathi Spooner: Um, and I've, I've been a fan of Russell Barkley for a couple decades now, and that, that's been one of his things.
• 10:06
  Cathi Spooner: And I really don't think that we look about that, we look at that very much.
• 10:11
  Cathi Spooner: And when we're looking at ADHD, especially if they've got a lot of hyperactivity or impulsivity, and they, they don't have that good inhibition capability.
• 10:25
  Cathi Spooner: If you look at the way the brain works, the neuroscience of emotions and the executive functioning process, then it makes more sense.
• 10:36
  Cathi Spooner: Um, so one of the things that we want to look at, if we have a child who has emotion dysregulation, and we want to, we want to look at some of the symptoms going on, because it might be undiagnosed ADHD.
• 10:53
  Cathi Spooner: And some of that emotion dysregulation may be part of that.
• 10:58
  Cathi Spooner: ADHD presentation.
• 11:00
  Cathi Spooner: The thing is, if we're also looking at ADHD, the likelihood we might be looking at some other co existing disorders along with that is pretty high.
• 11:11
  Cathi Spooner: So you want to make sure to look for the other things as well, um, like anxiety, depression.
• 11:19
  Cathi Spooner: Oppositional defiant disorder is one that comes along pretty regularly with that one.
• 11:24
  Cathi Spooner: Maybe on the autism spectrum and maybe they're having problems with sensory integration.
• 11:31
  Cathi Spooner: Um, and they may be overwhelmed with some of that sensory processing and that might be triggering the emotion dysregulation.
• 11:40
  Cathi Spooner: We may be looking at oppositional defiant disorder.
• 11:43
  Cathi Spooner: That's not one of my favorite disorders.
• 11:45
  Cathi Spooner: Because I often think when kids come in with presentation of oppositional defiant disorder, it's usually because the roots of that presentation are typically something else.
• 11:59
  Cathi Spooner: And so if you're looking at a child who's presenting with ODD, You most definitely want to look to see what some of those other roots may be.
• 12:10
  Cathi Spooner: Because here's the thing, if you only target the behavior and let's say you missed the ADHD or you missed the anxiety, then you have missed a huge trigger of your component of what's going on for that client.
• 12:28
  Cathi Spooner: You haven't successfully identified all of the roots in that symptom.
• 12:35
  Cathi Spooner: And when we're looking at the symptoms, we have really got to really identify what those roots are.
• 12:41
  Cathi Spooner: Sometimes it takes a little while to figure out because the roots are all kind of layered and they go different places.
• 12:49
  Cathi Spooner: If I love that analogy of the roots, think about a root system for a tree and how many different places those roots go.
• 12:56
  Cathi Spooner: Sometimes it may take a while to figure out what all the roots are.
• 13:00
  Cathi Spooner: The thing is, if we're using the idea of the Case conceptual case, clinical case conceptualization, my mouth will work eventually.
• 13:10
  Cathi Spooner: Clinical case conceptualization.
• 13:13
  Cathi Spooner: Then we want to make sure we are looking at all of the roots because case conceptualization drives the treatment and the diagnosis.
• 13:24
  Cathi Spooner: So if we miss out on some of what's going on, then our treatment approach is not going to be, it may not be effective at all, or it may not be as effective as it needs to be.
• 13:39
  Cathi Spooner: Um, the other thing that I think we often don't talk about is children who are gifted because sometimes, um, the way in which their brain works, I call, I call it, they have like a super powered brain.
• 13:54
  Cathi Spooner: Their, their brain processing goes super fast.
• 13:59
  Cathi Spooner: Uh, they get really frustrated with, I call the rest of us mortals.
• 14:04
  Cathi Spooner: My, uh, I've worked with a number of gifted kids.
• 14:08
  Cathi Spooner: I have a gifted husband and a gifted child, uh, so here's what I regularly say.
• 14:15
  Cathi Spooner: You have to learn how to live with the rest of us mortals.
• 14:18
  Cathi Spooner: We don't fire at the speeds that you fire, um, so you gotta learn how to live with us.
• 14:24
  Cathi Spooner: But it can be frustrating for them and their brain is always on.
• 14:30
  Cathi Spooner: It doesn't turn off.
• 14:33
  Cathi Spooner: So it it can be rather challenging and overwhelming for them.
• 14:38
  Cathi Spooner: So these are all of the things that we want to look at Trauma is another one.
• 14:43
  Cathi Spooner: So I think probably a lot of people are familiar with the trauma as well and emotion dysregulation.
• 14:50
  Cathi Spooner: We want to understand what are the triggers for trauma that are going to trigger some of that emotion dysregulation.
• 15:01
  Cathi Spooner: And full disclosure here, my dogs are in the room with me again.
• 15:07
  Cathi Spooner: And so if you hear some strange digging sound in the back, it was my crazy dog, Lily.
• 15:13
  Cathi Spooner: She is digging on my couch.
• 15:14
  Cathi Spooner: I don't know why she's so weird.
• 15:16
  Cathi Spooner: But anyways, uh, that's what that weird if you hear it.
• 15:21
  Cathi Spooner: So here are the things.
• 15:22
  Cathi Spooner: If you're looking vulnerabilities for emotion regulation, if the emotion regulation is the presenting symptom, then we want to look to what the roots are.
• 15:33
  Cathi Spooner: And so with autism spectrum, it can be, uh, cognitive inflexibility.
• 15:41
  Cathi Spooner: social reciprocity difficulties, just really hard doing that give and take.
• 15:47
  Cathi Spooner: They, uh, if they have, if they're on the autism spectrum, then they are also going to be struggling with sensory processing, uh, problems, and they can get overwhelmed by that.
• 16:01
  Cathi Spooner: If you're working with the child and maybe the roots of the emotion dysregulation, are grounded in anxiety.
• 16:09
  Cathi Spooner: You're looking at cognitive distortions that activate fear.
• 16:14
  Cathi Spooner: So you want to look at what is it that is activating those fear responses.
• 16:19
  Cathi Spooner: That's part of the case conceptualization.
• 16:23
  Cathi Spooner: Um, trauma.
• 16:25
  Cathi Spooner: We're looking at how are they assessing threat because they are not feeling safe.
• 16:32
  Cathi Spooner: All of the time, all of the time they don't feel safe.
• 16:35
  Cathi Spooner: So that can be overwhelming and they're gone to emotionally dysregulate.
• 16:42
  Cathi Spooner: If the trauma is the root of the emotion dysregulation, then that's going to be a very different treatment approach than if it's ADHD.
• 16:53
  Cathi Spooner: They often have overlapping symptoms.
• 16:56
  Cathi Spooner: So you really have to be really good at looking for what's underneath the symptoms.
• 17:02
  Cathi Spooner: So we have emotion dysregulation that can manifest with depression.
• 17:06
  Cathi Spooner: Uh, mood regulation can be, uh, based on some biological factors.
• 17:13
  Cathi Spooner: Maybe they didn't get enough sleep, or maybe they're not eating well, or maybe there's something going on with them that, like a sensory processing, we haven't necessarily figured out what those problems are.
• 17:29
  Cathi Spooner: If it's depression, then there's a lot of feelings of powerlessness and things like that.
• 17:36
  Cathi Spooner: So then, and finally, some of the, some of the ways that, uh, emotion dysregulation may show up, excuse me, get a drink for my coffee.
• 17:51
  Cathi Spooner: So we're looking at, uh, uh, executive function and how are, how are, how is that working?
• 18:00
  Cathi Spooner: If it's not working well, then that can create a lot of frustration for kids.
• 18:06
  Cathi Spooner: And if it's, especially if it's undiagnosed, um, ADHD.
• 18:11
  Cathi Spooner: School for kids with undiagnosed ADHD is torture, tortures.
• 18:17
  Cathi Spooner: Or it may be, the other thing, there may be an undiagnosed learning disability.
• 18:22
  Cathi Spooner: And so there's a sense of powerlessness.
• 18:25
  Cathi Spooner: There's a sense of I'm bad.
• 18:28
  Cathi Spooner: I must be stupid.
• 18:29
  Cathi Spooner: All of those are going to lead to self esteem problems, depression and anxiety.
• 18:38
  Cathi Spooner: So any, any number of these, we want to make sure to look for when we're conceptualizing what's going on with our client.
• 18:51
  Cathi Spooner: So those are some of just some things to think about the roots determine the fruits.
• 18:57
  Cathi Spooner: The case clinical case conceptualization is really all about figuring out what those roots are, what's going on underneath the behaviors.
• 19:11
  Cathi Spooner: So Facebook user says yes You did a fabulous job with this love going to Oh supervision groups somebody from my supervision group is on.
• 19:21
  Cathi Spooner: Yes.
• 19:21
  Cathi Spooner: Awesome Yes, and that's one of the things that we do to me Supervision group is a really good way.
• 19:30
  Cathi Spooner: We do that a lot in our supervision group like my Facebook user friend said is we'll look at what is going on?
• 19:41
  Cathi Spooner: Because you If we don't understand, uh, if we don't identify that, then we, we may go the wrong way with the treatment.
• 19:51
  Cathi Spooner: So here are some, here are some tips for, um, I made these really cool banner things.
• 19:59
  Cathi Spooner: I want to use them.
• 20:01
  Cathi Spooner: There we go.
• 20:02
  Cathi Spooner: That's my banner thing.
• 20:04
  Cathi Spooner: Um, Here's some tips.
• 20:07
  Cathi Spooner: A really good psychosocial.
• 20:10
  Cathi Spooner: Meaning you want to do a, uh, do a really thorough psychosocial assessment.
• 20:16
  Cathi Spooner: And when you're looking at symptoms, when you are asking parents about symptoms, you want to think frequency, duration, and intensity.
• 20:26
  Cathi Spooner: These are key in your head.
• 20:29
  Cathi Spooner: Memorize these in your head, say them all the time in your head.
• 20:32
  Cathi Spooner: If your, if your parent says to you, my client has temper tantrums, you want to ask how often they occur, how long they last, and if you were to rate them on a scale of zero to 10, zero means it's not bad at all.
• 20:49
  Cathi Spooner: 10 means it's so bad your head's going to pop off.
• 20:52
  Cathi Spooner: how would you rate the intensity?
• 20:54
  Cathi Spooner: Because that helps us to get an understanding from their point of view, what it is like.
• 21:02
  Cathi Spooner: So frequency, intensity, and duration, you, you, you really need to think that way when you're doing a really good, thorough psychosocial assessment.
• 21:11
  Cathi Spooner: I can't tell you how many times I've gone in and I've had parents say to me, It's really, really bad.
• 21:18
  Cathi Spooner: It's really, really terrible.
• 21:20
  Cathi Spooner: Um, and then I'll ask frequency, duration, and intensity questions, and they'll say the frequency occurs, uh, maybe, maybe like two times a week.
• 21:30
  Cathi Spooner: Um, how long does it last?
• 21:34
  Cathi Spooner: Uh, probably like 10 minutes.
• 21:37
  Cathi Spooner: And then if you were to rate it on a zero to 10, um, I'd say probably a six as opposed to frequency in terms of intensity and duration, how often that they occur daily.
• 21:53
  Cathi Spooner: When they have meltdowns, how often does it last?
• 21:56
  Cathi Spooner: It could go on like two or three hours.
• 21:59
  Cathi Spooner: I'm exhausted.
• 22:01
  Cathi Spooner: If you were to rate the intensity, I'd, I'd rate it typically a seven or an eight.
• 22:08
  Cathi Spooner: Does that make sense to you guys?
• 22:10
  Cathi Spooner: Like how, if you ask frequency, intensity, and duration, those are two very different clinical presentations.
• 22:18
  Cathi Spooner: If you have emotion dysregulation happening daily and it'll last like two or three hours, the likelihood that's a more severe and probably a number of things going on versus maybe happens a couple of times a week and it lasts 10 minutes and the intensity is like a five or a six.
• 22:39
  Cathi Spooner: We still need to address the less severe one, um, So, uh, but the, if you ask the questions though, you get a better understanding of what's going on to help you with your clinical decision making.
• 22:55
  Cathi Spooner: I mean your clinical conceptualization, because how you conceptualize it will then, um, determine how, what the treatment process, like what kind of modality are you using?
• 23:09
  Cathi Spooner: It'll determine how often you see a client.
• 23:13
  Cathi Spooner: Um, so maybe you see them weekly.
• 23:14
  Cathi Spooner: I always like to see kids weekly in the beginning.
• 23:18
  Cathi Spooner: Um, how are you going to pace the sessions because if they get dysregulated pretty easily, um, in the sessions, then you, you probably want to look at, are they feeling safe and secure in that session?
• 23:33
  Cathi Spooner: So all of these things matter, asking the questions.
• 23:37
  Cathi Spooner: You most definitely want to ask about developmental history.
• 23:42
  Cathi Spooner: What was mother's pregnancy like?
• 23:44
  Cathi Spooner: Were there any complications at, during the pregnancy or at her birth?
• 23:49
  Cathi Spooner: Or how did they, how did they do with sleeping, especially in the early years?
• 23:55
  Cathi Spooner: How did they do with some of those early developmental milestones?
• 23:58
  Cathi Spooner: Because if you're looking at something that's more of a developmental delay, or even possibly like ADHD.
• 24:06
  Cathi Spooner: You, the likelihood you may see some of these symptoms early in their development is pretty darn high.
• 24:14
  Cathi Spooner: So make sure you ask about developmental history.
• 24:17
  Cathi Spooner: I always ask about school.
• 24:20
  Cathi Spooner: I ask, how did they transition?
• 24:22
  Cathi Spooner: Did they go to preschool?
• 24:24
  Cathi Spooner: How did they transition into preschool?
• 24:26
  Cathi Spooner: How did they get along with kids?
• 24:27
  Cathi Spooner: How did they get along with their teachers?
• 24:30
  Cathi Spooner: How did they get along with, um, the other, how did, how did they get along?
• 24:36
  Cathi Spooner: How well did they do with learning?
• 24:38
  Cathi Spooner: Whatever it is they had to learn.
• 24:40
  Cathi Spooner: I want to ask that to kindergarten.
• 24:42
  Cathi Spooner: Kindergarten is another big transition point.
• 24:45
  Cathi Spooner: So how did they transition into kindergarten?
• 24:48
  Cathi Spooner: Third grade is another really big transition point.
• 24:51
  Cathi Spooner: So I want to ask how they did with third grade if they're like in fourth or fifth.
• 24:55
  Cathi Spooner: Middle school, another ginormous, ginormous transition.
• 25:02
  Cathi Spooner: So you want to ask how they did with the transition.
• 25:05
  Cathi Spooner: How did they get along with their peers?
• 25:08
  Cathi Spooner: How did they get along with their teachers?
• 25:10
  Cathi Spooner: Academically, how did they do?
• 25:12
  Cathi Spooner: That's going to give you a lot of good information because If there's an undiagnosed learning disability or the potential for ADHD or even the potential for being on the autism spectrum, you're, these are things that are going to show up in how they did in school and how they're doing in school.
• 25:38
  Cathi Spooner: Here's a, here's a perfect example.
• 25:40
  Cathi Spooner: I had a client come to me and this, so the client that came to me, Um, at the time was 16 and this client had been in counseling at, since the, uh, since like third grade.
• 25:59
  Cathi Spooner: That's a lot of time.
• 26:02
  Cathi Spooner: And throughout that entire time, that's like half this person's life.
• 26:06
  Cathi Spooner: They were constantly in counseling.
• 26:11
  Cathi Spooner: And when they came to me, one of the things that the mom asked was, do you think it might be autism spectrum?
• 26:20
  Cathi Spooner: So this is a person who had been in counseling from the age, uh, from third grade until now, like 11th grade.
• 26:30
  Cathi Spooner: That's eight years.
• 26:32
  Cathi Spooner: No one ever asked or explored.
• 26:36
  Cathi Spooner: Was there the possibility of something else going on in those roots?
• 26:42
  Cathi Spooner: And it turns out once this was like my very first, very first meeting, like this is a 15 minute meeting.
• 26:49
  Cathi Spooner: It's always longer than 15 minutes.
• 26:51
  Cathi Spooner: And so once I started asking some of those questions going into my super sleuth mode, it became pretty obvious that the likelihood it was undiagnosed autism spectrum was pretty high or some kind of learning disability.
• 27:04
  Cathi Spooner: I, I'm a firm believer if you suspect, uh, developmental delay, um, like autism, or you suspect autism spectrum or ADHD or something that has to do with a lot of brain processing, I'm a really good, I'm I'm a fan of getting really good clinical neuropsychological testing.
• 27:29
  Cathi Spooner: Sometimes that's hard if if parents don't have the money to pay for it.
• 27:35
  Cathi Spooner: Um, which I always feel really bad for families that have Medicaid because the likelihood they have access to really good psychological testing unless you live in an area where that's possible.
• 27:50
  Cathi Spooner: Um, there are a lot of areas where that isn't possible just because of the, the cost of psychological testing.
• 28:01
  Cathi Spooner: If you do, though, I, I'm a huge fan of recommending getting some testing and making sure that it's somebody who's really good and knowledgeable about how to, uh, assess for ADHD and autism spectrum or learning disability.
• 28:22
  Cathi Spooner: I had a, I think this is when I was working in a residential program and we had a, an adolescent girl come and I was sure I was so sure she was on the autism spectrum and that we had a phenomenal, uh, psycho clinical psychologist and he did the testing and he was so, so good.
• 28:43
  Cathi Spooner: And it turned out she was, uh, here, I'm going to pull up my big psychology words here, Prodromal, um, Schizophrenic.
• 28:53
  Cathi Spooner: Um, and once he went through all the testing and the data he had gotten, it was really clear that that's what was going on.
• 29:04
  Cathi Spooner: Those are two very different routes.
• 29:06
  Cathi Spooner: Um, two different treatment processes in, in many, many ways.
• 29:11
  Cathi Spooner: So, so the way in which I conceptualized the treatment worked in some ways because of the, the social component that learning how to be social, learning how to regulate emotions, tolerate distress, those are still pretty useful.
• 29:28
  Cathi Spooner: But we were looking at a different kind of long term treatment outcomes and a different way in which we want to develop support for that particular client.
• 29:40
  Cathi Spooner: So this is why to me, it's really important to gather good information, if you suspect that it might be ADHD or autism spectrum, or some kind of learning disability, or, something more, much more organic.
• 29:59
  Cathi Spooner: You really want to recommend getting further testing because that can provide some really good information.
• 30:05
  Cathi Spooner: The other thing is you want to make sure you get a good family history that can tell you so, so much.
• 30:13
  Cathi Spooner: If you have a client, I had this happen to me once again, another, she was five.
• 30:21
  Cathi Spooner: Um, She went to, she had gotten testing, testing the, and the psychologist said, but because she had emotion dysregulation that she had bipolar disorder.
• 30:35
  Cathi Spooner: When I gathered the family history, mom had ADHD, dad had ADHD, sister had ADHD, I, aunts and uncles, no one in the family had bipolar.
• 30:51
  Cathi Spooner: So the likelihood, and if we go back to, um, understanding that emotion dysregulation can be part of an ADHD presentation, because especially for a five year old, they're learning how to regulate their emotions.
• 31:09
  Cathi Spooner: So, developmentally, you want to look at what stage of development are they in.
• 31:14
  Cathi Spooner: Um, again.
• 31:17
  Cathi Spooner: And this is where, to me, gathering a really good family history, asking questions, don't necessarily assume that family members are going to know diagnoses.
• 31:29
  Cathi Spooner: So you need to be able to ask specific questions like, um, did any, is there any history of anyone reporting, uh, sexual abuse or physical abuse or, um, emotional abuse or rape.
• 31:48
  Cathi Spooner: Or anyone have a history of addiction to alcohol?
• 31:54
  Cathi Spooner: To drugs?
• 31:55
  Cathi Spooner: You want to make sure to ask these questions.
• 31:58
  Cathi Spooner: Any history of depression, feelings of hopelessness and helplessness, fatigue.
• 32:04
  Cathi Spooner: Difficulty getting out of bed.
• 32:05
  Cathi Spooner: Anyone have a history of being hospitalized for mental health reasons?
• 32:10
  Cathi Spooner: Make that like, go back to your Genogram days.
• 32:13
  Cathi Spooner: These are really good questions.
• 32:15
  Cathi Spooner: You get a lot of good information.
• 32:17
  Cathi Spooner: It is time consuming.
• 32:19
  Cathi Spooner: That is true.
• 32:20
  Cathi Spooner: The, the, the benefit though is if you ask a lot of really good questions, then you're going to get a lot more information to help you better understand and conceptualize what's going on.
• 32:37
  Cathi Spooner: Because when you're conceptualizing and you're now you've gathered all of this information and based on all of that information, you're going to come up with the diagnosis and your treatment plan.
• 32:50
  Cathi Spooner: So how often are you going to see somebody?
• 32:54
  Cathi Spooner: What types of interventions are you going to use?
• 32:57
  Cathi Spooner: What theory model are you going to use.
• 33:00
  Cathi Spooner: So if I have a five year old with emotion dysregulation the likelihood I'm going to use child centered play therapy as opposed to maybe cognitive behavioral therapy to address the behaviors is pretty pretty high because a five year old, it's really hard to do cognitive behavioral therapy with a five year old.
• 33:25
  Cathi Spooner: Um, that's just developmentally not typically where they are.
• 33:29
  Cathi Spooner: So all of those things go into my treatment conceptualization and what I want to be working on.
• 33:38
  Cathi Spooner: So here's the thing.
• 33:39
  Cathi Spooner: What happens if you miss the mark?
• 33:42
  Cathi Spooner: If you miss the mark, then your whole, I like to, I love a good metaphor.
• 33:46
  Cathi Spooner: So if we're using roadmap, let's use GPS.
• 33:49
  Cathi Spooner: GPS helps us navigate.
• 33:52
  Cathi Spooner: And so when we're, if we're, we have our GPS on and we're trying to find out where we need to go.
• 33:58
  Cathi Spooner: If we take a wrong turn, then our GPS goes, uh, What does it say?
• 34:04
  Cathi Spooner: Uh, basically it's reprocessing to find another alternative route to get you back on track.
• 34:12
  Cathi Spooner: So in that, if, if we're not conceptualizing effectively, then, and then our clinical decision making is not going to be as effective because our GPS is going to be faulty and not working very well.
• 34:30
  Cathi Spooner: It won't be able to help us get back on track.
• 34:33
  Cathi Spooner: The, the way in which we conceptualize the presenting issues then also helps us determine how we're going to treat.
• 34:43
  Cathi Spooner: And then once we're in that treatment process, then we're constantly doing that clinical decision making.
• 34:50
  Cathi Spooner: And we're always in super sleuth mode.
• 34:53
  Cathi Spooner: That's how I look at it.
• 34:54
  Cathi Spooner: We're always in detective mode.
• 34:56
  Cathi Spooner: Every session gives us more information to help us make sure our clinical conceptualization is on track.
• 35:04
  Cathi Spooner: And then that's going to help us with our clinical decision making.
• 35:09
  Cathi Spooner: So, um, that, that is it for today.
• 35:15
  Cathi Spooner: So just kind of a recap.
• 35:17
  Cathi Spooner: Um, The clinical case conceptualization, the roots determine the fruits.
• 35:23
  Cathi Spooner: You really want to go and see what is under the surface where the roots exist.
• 35:29
  Cathi Spooner: What kind of roots are, what's going on down there because whatever is going on underneath the symptoms is really where we want to target because if we only target the symptoms, we may miss a whole, whole bunch of really important aspects to what's going on for our client.
• 35:51
  Cathi Spooner: And then our treatment may not be as effective.
• 35:54
  Cathi Spooner: And in order to get a really good, clinical case conceptualization, you have really got to do a thorough history taking.
• 36:04
  Cathi Spooner: And then that's ongoing.
• 36:05
  Cathi Spooner: Every session is going to give you more data to help you make sure that you are understanding what's going on.
• 36:14
  Cathi Spooner: Because we don't, I mean, we don't always know from the beginning, even when we do a really good, thorough history taking over time as we interact with our client and we get to know them better and they get to know us better and we can see more things, then we're likely going to see more of what's going on below the surface where those roots exist.
• 36:38
  Cathi Spooner: So I, I really think we're always in detective mode.
• 36:43
  Cathi Spooner: And then finally, The thing is, if we, if we miss the mark, so to speak, then now it's going to make our treatment much less effective.
• 36:57
  Cathi Spooner: And if our goal is to help our clients really, really overcome and make the change, then we really need to make sure that we're on our game and doing our part.
• 37:11
  Cathi Spooner: That's, that's our part.
• 37:12
  Cathi Spooner: Our part is to figure out what's going on, make sure that we are collecting data, so to speak, that's going to help us with our clinical decision making as we move through the treatment process.
• 37:29
  Cathi Spooner: And to me, one of the, that, that's one of the things that we talk about a lot in supervision.
• 37:37
  Cathi Spooner: And I really think that supervision is a really good way to help learn how to do that because the thing about supervision is, and we do this a lot in my online supervision group, we will, uh, somebody will, will talk about you know what what's going on with their clients?
• 37:56
  Cathi Spooner: And then we go into super sleuth mode.
• 37:58
  Cathi Spooner: What's going on?
• 37:59
  Cathi Spooner: I ask a ton of questions, really to kind of help the, uh, professionals in the group learn to think about, Oh, yeah, it might be this and help to grow their skills and knowing how to be a good detective and create that case conceptualization that's going to drive the treatment process and help you figure out what kind of interventions you want to make sure that you're using.
• 38:28
  Cathi Spooner: All righty, so that is it for today and I will see you next week.
• 38:39
  Cathi Spooner: Thank you for joining me on this episode of Next Level Play Therapy.
• 38:44
  Cathi Spooner: I hope you found the discussion valuable and gained new insights and ideas to support your work helping children, adolescents, and families heal.
• 38:53
  Cathi Spooner: If you enjoyed this episode, be sure to subscribe to the podcast and leave a review.
• 38:59
  Cathi Spooner: Your feedback helps to improve and reach more people who can benefit from this information.
• 39:05
  Cathi Spooner: Remember, Play therapy is a powerful tool for healing and growth.
• 39:09
  Cathi Spooner: Whether you're a new play therapist or experienced, I encourage you to continue your learning journey to unlock the potential of play in your own work and relationships.
• 39:20
  Cathi Spooner: If you have any questions or topic suggestions for future episodes, I'd love to hear from you.
• 39:27
  Cathi Spooner: Connect with me on social media and visit my website at Renewing Hearts Play Therapy Training to stay updated on upcoming episodes, trainings, and resources.
• 39:40
  Cathi Spooner: Thank you once again for listening to Next Level Play Therapy.
• 39:44
  Cathi Spooner: Until next time, keep playing, learning, and growing.