Somatic Interventions for Play Therapy with Traumatized Children

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Somatic Interventionsfor Play Therapy with
Traumatized Children

• Blackbird Family Therapy, Inc.
• A licensed marriage and family therapy
  corporation.

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Outline

• Introduction to Somatic Therapy
• Basics of Somatic Trauma Therapy
• When and Why to Use Somatic Work in Play Therapy
• How to use Somatic Interventions in Play Therapy

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Intro What Is Somatic Therapy?

• Somatic therapy focuses on how emotions and
  memories are expressed in the body.
• Emphasis is on how things feel rather than what
  one thinks
• Client I know that I'm a good person, but I
  don't feel that way.
• Therapist Where do you feel that way in your
  body?
• Client I feel it like a heaviness in my heart.
• Therapist What is it like to place your hand
  where it feels bad?
• Client It feels a little better.

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Intro How does ST Work?

• Basic tools of somatic therapy include body
  awareness and intentional use of the afferent
  nervous system (from the body to the brain).
• Although rarely advertised as such, many somatic
  interventions resemble behavioral interventions
  such as progressive relaxation,
  counterconditioning, affect tolerance, and
  exposure therapy.

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Intro What else is Somatic Therapy?

• Dance
• Athletics
• Meditation (e.g. Vipassana)
• Yoga
• Getting up Lying Down
• Talking Funny
• Patticake
• Laughing
• Skipping
• Horse Lips
• Blowing Raspberries

• Yawning
• Napping
• Rocking
• Jiggling
• Sighing
• Patting
• Humming
• Squatting
• Moaning and Growning
• Stretching
• Playful Retching

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Basics of Somatic Trauma Therapy

• Track conditioned physiological responses to
  trauma in both therapist and client
• Intervene with a resource that allows body
  awareness (because all trauma responses involve a
  lack of body awareness)
• Teach client that s/he can handle similar
  responses in the future (with kids, this often
  done through modeling attachment work)

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Basics Responses to Trauma

• Fight we prepare to confront a potential
  aggressor or predator anger, adrenaline, blood
  flow to muscles
• Flight we prepare to flee a potential aggressor
  or predator fear, adrenaline, blood flow to
  muscles
• Freeze in situations where fight or flight are
  either impossible, or where these strategies
  fail, we freeze and prepare to survive the trauma
  dissociation, endorphin release, blood flow to
  head and chest
• Children, and even therapists, often go into some
  form these responses when they are triggered by
  an internal or external cue that reminds them of
  a trauma. Often, as compassionate and empathic
  adults, we follow along with our clients
  unconsciously as they are triggered.

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Basics Freeze States

• Freeze states often appear as combination of ANS
  PNS symptoms, likely because the body is
  simultaneously preparing for flight or fight
  responses while also freezing
• Like stepping on the gas and brakes at the same
  time
• Freeze states are more associated with people who
  develop PTSD
• PTSD symptoms resemble both the activation of the
  SNS hypervigilence, startled response, as well
  as PNS dissociation, numb feelings, memory loss

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Basics How To Pull Out of a Trauma Response

• Bring awareness to your whole body, especially
  your hands and feet
• Take slow, deep breaths, yawn
• Intensely look at something you can see right
  now
• Do something fun or different with your body...

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Basics What Does Somatic Therapy Feel Like?

• EMDR Light Stream Exercise

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Basics Other Ways to Pull Out of Trauma Response

• Dance
• Athletics
• Meditation (e.g. Vipassana)
• Yoga
• Getting up Lying Down
• Talking Funny
• Patticake
• Laughing
• Skipping
• Horse Lips
• Blowing Raspberries

• Yawning
• Napping
• Rocking
• Jiggling
• Sighing
• Patting
• Humming
• Squatting
• Moaning and Growning
• Stretching
• Playful Retching

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When to use Somatic Interventions in Play Therapy

• With Yourself and Caregivers
• When a child is stuck in a PTSD reaction such
  as fear, dissociation, or aggression usually
  the child is unable to express the theme of the
  trauma in play
• To consolidate gains and resource

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When Working with Yourself Caregivers

• Put on your own air mask before putting on your
  child's.
• Learning to regulate your own nervous system as a
  way of non-verbally teaching a child to do the
  same.
• Winnicott and the holding environment
• Resolving attachment through connection to a safe
  object vs. mirroring learned helplessness
• Mirroring statements vs. mirroring affect
• Learning to unmirror or break a trauma habit.

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When Working with Caregivers

• After you teach a parent or caregiver to put on
  their own mask, it can be helpful to teach them
  to do the following both in session (if
  applicable) and at home
• Therapeutic Touch
• Stroking, soothing
• Hugging, rocking
• Coaching parent to stay present in their body
  with child to model how to do so for child

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When Attachment Work

• Children always heal from trauma in the context
  of a safe and secure attachment bond.
• By strengthening the attachment bond, you are
  working on the trauma itself.
• You can train a caregiver to be able to handle a
  traumatized child's emotional dysregulation as
  well as questions about an event.
• Play therapy that involves the caregiver, along
  with somatic touch related interventions, are
  best.

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When A child is stuck

• Flight a child is scared
• Fight a child is angry
• Freeze a child is scared and frozen or spacey,
  can also be over cooperative
• The child is unable to express their situation in
  play, and instead acts out their situation
  concretely in relationship to you and others.
• The goal is to intervene to allow the child the
  ability to use play to work through the trauma.

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When Resource Consolidate Gains

• Resource something that was not available to the
  child at the time of the traumatic event that is
  available now strength, loving adults, ability
  to say no and tell adults, etc.
• Building and developing resources helps children
  feel that they could handle the trauma if it
  happened again
• Resources can be internal superheroes, good
  feelings, and external, actual people.
• Resources can be physical acts and sensations.

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How To Use ST In Play Therapy for Trauma

• Identify the Trauma Response Flight, Fight,
  Freeze, through countertransference and/or
  observation
• Bring in a resource
• Complete the trauma response and/or choose a more
  appropriate one

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How Working with Fear / Flight

• Fear often mobilizes energy for us to run from a
  situation, often in the legs, but also in the
  muscles in general.

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How Working with Fear / Flight

• Completing the Response
• Where do you feel the fear in your body?
• If in the legs, what would be like if we got up
  and ran around with that energy in a circle?
• Changing the Response
• Yell no at the fear and push it away with your
  arms.

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How Fear Resources

• Tell me about someone who could handle this
  without being afraid? (Superheroes, family,
  cartoon video game figures)
• Draw a picture of this person, show me how s/he
  acts
• Imagine that you are that person, how does that
  feel in your body? Notice that feeling.

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How Working with Aggression

• Aggression often mobilizes muscles in the
  shoulders, arms, and chest. There is often a
  great deal of upper body readiness.
• The goal is often to complete the response, so
  the person can feel that they are able to protect
  themselves and feel safe.

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How Working with Aggression

• Pushing Away with Arms
• Saying no
• Patticake
• Stomping feet

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How Working with Freeze

• Freeze states show up as dissociation, lack of
  body awareness, numbness, going into your head
• Freeze states often happen in combination with a
  flight or fight response, like pushing on the gas
  and breaks at the same time
• The goal is to bring the client back into body
  awareness, and then complete a different response
  such as flight or fight.
• Freeze states are associated with PTSD and are
  very common with sexual abuse.

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How Working with Freeze

• Activity of any kind is the key, as well as body
  awareness. Almost any somatic exercise will work
  with a freeze state.
• Jumping up and down, running around
• It can be nice to choose an activity that would
  represent a different response or complete one,
  such as kicking or pushing for aggression, or
  running or walking for fear.
• Pleasant, fun, and goofy activities are good too.

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Final Exercise

• Pair up with one other person here who you don't
  know
• Tell each other who each you used as your
  difficult person in the last exercise
• Decide who will go first
• Each of you will choose an appropriate play
  therapy somatic intervention for the other from
  the handout
• Take turns performing your assigned interventions
• Check in and see what happened.

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More Information

• You can download this presentation on the Web
• http//matthewlindgren.com/EMDR-classes-consultati
  ons/somatic-play-workshop.html
• The first activity with the light visualization
  is from the very first part of the EMDR protocol,
  in which you prepare clients for work by
  resourcing.
• The activities for the final exercise are from
  Embodying Well Being, by Julie Henderson.
• The information about trauma responses and
  physiology are from Somatic Experiencing
  trainings.