Neurobiologically Guided Play Therapy

Neurobiologically Guided Play Therapy

Presented by:Richard L. Gaskill, Ed.D. RPT-SSumner Mental Health Center

Wellington, KS [email protected]

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All rights reserved © 2011 Rick Gaskill and The Child Trauma Academy

Our civilization is still in a middle stage, scarcely beast, in that it is no longer guided by instinct, scarcely human in that it is not yet wholly guided by reason.

Theodore Dresier

Our Brain Was

Designed for Different

Age.


Greek Philosophers

Ancient Greeks separated reason from passion, thinking from feeling, cognition from emotion.

These aspects were viewed as an inner battle of the psyche.

LeDoux, 1996All rights reserved © 2011 Rick Gaskill and The Child Trauma Academy

Plato Reasoned

Emotions are like wild horses that have to be reined in by the intellect, which is like charioteer controlling wild horses.


We continue to separate the two

Today, we study rationality (cognitive science), independent of emotions

Cognitive science was described as the “new science of the mind”

Behaviorists believed that inner states of the mind were not measurable.

Behaviorists were known to ridicule those who dared speak emotion and consciousness.

LeDoux, 1996


Neither is The Full Story

Minds without emotions are not really minds at all.

They are cold lifeless creatures devoid of desires, fears, sorrows or pleasures.

They are souls on ice

LeDoux, 1996


Critical Fundamental Principle(The Use Dependent Brain)

The brain develops and organizes as a reflection of developmental experience, organizing in response to the pattern, intensity, and nature of sensory and perceptual experience.

Perry, 2004All rights reserved © 2006-2011 Bruce D. Perry and The ChildTrauma Academy

Key Social-Emotional Trauma Facts

Psychosocial trauma negatively impacts all areas of brain development and functioning.

Social-emotional trauma arouses low brain structures, inhibiting the CNS.

The rational executive brain is largely inadequate to control emotional arousal or to change fixed low brain patterns.

Traumatic experiences can permanently alter basic brain function.


The Brain: a bottom up organization

Primitive brain reactions occur immediately, to stored patterns associated with threat

This is a nonverbal, illogical, unconscious association

Alarm activation occurs before Cortex processing

Brainstem and Diencephalon posses little subjective perception

Resulting dysfunctional relational interaction is beyond awareness and understanding of child, youth, or adult. (Perry,2006; Perry & Marcellus 1997)


An Uncomfortable Reality:Children are More Vulnerable

The organizing brain is more malleable

Trauma becomes the neural organizational set point/homeostatic state

Perry (2006); Van der Kolk, Spinazzola, Baustein,Hopper,Hopper, Korn, & Simpson (2007)


The Therapeutic Conundrum!

If severe enough, the child will be “brainstem” driven. They will think and act in very primitive ways, being less accessible to academic and therapeutic interventions using words or therapeutic relationships as motivational agents of change.

(Perry, 2006)


Negative Impact of Neglect/Trauma

Attachment Marital Work Children Legal Status

Cognition Lower IQ Faulty thinking Perceptual errors

Biology Illness/ Disease Life span

Affect Regulation Emotional modulation

Dissociation Withdrawal Cutting, picking, burning Pseudo seizures

Behavioral Control Impulse control Anger control

Coordination/BalanceSelf-concept

Cook et al, 2005


Outcomes for Adults vs Children

Onset of Trauma % Asymptomatic Ratings

Adult 75%

Childhood 33%

van der Kolk, et al., 2007


PTSD Affects: hippocampus, prefrontal cortex, amygdale

Declarative Verbal Memory Learning Complex Cognitive

Functions Personality Expression Decision Making Social Behavior Social Evaluative Skills Impulse Control Sensory, Visual Decision

Making Respiratory Control Hallucinations Smaller Brain Volumes

DeBellis, Baum, et al., 1999


Brain Connectivity

IQ is not fixed at birth700 Neural connections

per second. 50% IQ abilities by 4

yrs.30% between 4 and 7

yrs80% by 8 yearsEnvironment determines

IQTrauma may decrease

working memory by 20%

Evans, 2009; Stevens, 2011


Basic Neuro-Developmental Principles

The Human Brain is “Use Dependent” (reflects our experience)

Stress Moves The Locus of Control Down (From Thinking to Feeling to Reacting)

Neurosystems Activated Change to Reflect the Pattern of Activation

Parts of the Brain not Activated Don’t Change



The Brain Develops in a Hierarchical Order (lower functions before higher functions)

The Developing Brain Regions are Sensitive to Specific Experiences during Specific Developmental Periods

What One Part of the Brain Knows Another Part Does Not Know.

Social Mastery Grows in the Child’s Comfort Zone.



Island of Security/Comfort: Familiar Safe Predictable Routine Nurturing

The Brain is a Pattern Seeking Device (it seeks what is familiar)


Traditional Issues Treated with Play Therapy

(Landreth, Homeyer, Glover, and Sweeney, 1996)

Abuse NeglectAggression/Acting outAttachment DifficultiesAutismChronic IllnessPhysical HandicapsDissociationSchizophreniaWithdrawn ChildrenTraumatization

Emotional DisturbanceEnuresis and EncorpresisFear/AnxietyGriefHandicapped Reading DifficultiesSelf-Concept Self-EsteemSpeech Problems


Typical Play Therapy ThemesNorton & Norton, 1992; Sweeney, 1994

Power/ControlEmpowermentConfusionLoyalty/BetrayalViolation/ProtectionAdjustment/ChangeGuilt/Self-BlameLoss/Death

Anger/SadnessFears/AnxietyTrust/Relationships/

AbandonmentBoundaries/IntrusionIdentitySelf-EsteemSelf-Worth


Neglect of The Sensate Dimension of Trauma

Traditional therapy promotes understanding and insight into what is happening in the patient’s life that stirred up powerful emotions

Most therapies pay scant attention to traumatic changes in body experience

Brain science demonstrates the origin of emotional states is conditions of our bodies: body’s chemical profile, the state of our internal organs, muscle contractions in our face, throat, trunk, and limbs.

van der Kolk, 2004


Decision Making; Planning; Morality/Ethics/Values; Guilt; Self- Blame; Power/Control; Adjustment/

Change; Boundaries/Intrusions; Self-esteem/Self-worth; Identity

Anger/Sadness/Fear; Trust/Relationships/Abandonment

/Nurturing; Security; Violation/Protection;

Separation/Death/Loss Loyalty/Betrayal;

Tradition Play Therapy is effective for these issues, but is not well suited for non-verbal, low brain associative learning (non-declarative memory) that is unresponsive to language, insight, logic, and or understanding

Multi Level Processing


Difficult DSM-IV Diagnoses and Symptoms

Diagnoses:PTSDAcute Stress DisorderDepressive EpisodesDissociative ReactionsAnxiety DisordersPhobiasPanic DisordersReactive Attachment

Disorders

Symptoms:FearHorrorDisorganized ThoughtsIntrusive MemoriesIntrusive DreamsFlashbacksPsychological DistressPhysical DistressNumbingMemory Problems


Symptoms Continued

Feeling DetachedRestricted AffectSleep DifficultiesIrritabilityHyper vigilanceExaggerated Startle

ResponseUnreasonable

Anxiety Response to Exposure

Vegetative Signs Sleep Problems Appetite Problems Loss of Energy Wt Gain/Loss Fatigue

Deteriorated Cognition

Poor Concentration


Sleep, disturbing dreams; intrusive memories; appetite,

feeding energy, primary sensory integration; motor

coordination, balance motor planning anxiety, detachment,

numbing,

Autonomic Arousal; ANS disorders; anxiety; startle

response; physiological distress; fight/ flight response; W t

Loss/Gain; hyper vigilance; attention; concentration;

irritability breathing; BP; HR. fatigue,

Multi Level Processing


Traditional Treatments

The dorsolateral prefrontal cortex (insight, understanding, and planning) has virtually NO connecting pathways to low brain centers.

van der Kolk, (2004, 2006)


Traditional Treatments

Psychodynamic, Experiential, & CBT Play Therapys which emphasize understanding, emotional processing, insight, and problem solving pay insufficient attention to disturbed autonomic physical sensations and preprogrammed physical actions.

These therapies fail if the brainstem and diencephlon is poorly regulated

(van der Kolk, 2004, 2006; Perry, 2006)


The Conundrum

Unfortunately, there is an absence of evidence-based information available on effective treatment for complex trauma in children.

Malchiodi, 2008


So, What Can We Do?

Rather than put all traumatized children into a one-size-fits-all, easy-to-export, 20 session group treatment protocol, we should look back.

There is something to be learned from our ancestors.


Treatment Must Access the Brain at the Level of Trauma

The Child must Feel Safe

Treatment must focus on the Disregulated brain location

Treatment must create Positive Feelings (Reward)

Interventions must be Compatible with brain level

Treatment must be Hierarchical All rights reserved © 2011 Rick Gaskill and The Child Trauma Academy

Core Elements of Positive Developmental Experiences:

Relevant (Developmentally Matched)Repetitive (Patterned)Relational (Safe)Rhythm (Resonate with Neural

Patterns/Positive Entrainment)

(Processes are rooted in neurobiological elements)

Perry, 2008


Keys to Interventions

Psycho-Social Ratio/Interventions must match developmental age

Interventions must activate the brain region disorganized

Interventions must be patterned and repetitive

Interventions should be fun

Interventions must begin at the lowest disorganized brain level


Possible History of Problems

Attention/ Tracking Problems Importance of Stimuli Identification of a Stimuli Focusing Attention on a

Stimuli Sensory Integration Issues

Core Arousal Regulation Problem Can’t Quiet Physiological

Arousal / Poor Regulation Transitioning Between

Arousal States Overly Reactivity to

stimuli Tantrums Does not sleep well Irritability

Metabolic Issues Wt/Ht gain/Obesity/Anorexic Hording, Gorging, Purging Poor Regulation of Physical

Functions Cardio/Resp/ANS

Irregularities High/Low/Erratic Heart

Rate Blood pressure Swallowing, Gag reflex Respiratory Difficulties Asthma, Allergy, Sleep

Apnea, Diabetes, Diarrhea, Constipation, IBS, Dermatitis, Hives, Rashes


Research Has Shown:

“Self-regulation is the ability to control one’s ownemotions, behaviors, and thinking processes.”

“The growth of self-regulation is the cornerstone of

early childhood development that cuts across alldomains of behaviors…..”

Zigler,Singer,& Bishop-Josef, 2006All rights reserved © 2011 Rick Gaskill and The Child Trauma Academy

Development of Self-Regulation

Requires an Attuned Caregiver:

Requires Developmentally Appropriate Activities Sensory/ Movement Regulation Relational Regulation Self-Regulation


Attunement Through Mirror Neurons

Superior Temporal Sulcus (STS): a fold in the cortex

Integrates information regarding form, location, and motion.

Neurons are activated when we see others engaging in functional behavior

Or when we engage in these actions

Supports emotional resonance, attunement, and empathy with others

Cozolino, 2006


In An Attuned State

Caregiver meets child’s basic needs

Caregiver has calm, open emotional state

Through eye contact, mutual gaze, facial contact

Creates a harmonic meeting of minds

Neural activity synchronizes in right cortex

EEG’s are actually in sync Heart rates synchronize Hormonal system

synchronizes Critical to later self-

regulation Children who don’t

experience this have trouble forming healthy attachments

Stern, 1985


Important Treatment ConceptsAGE Brain

AreaDevelopmental

GoalDev Social

RatioPlay Therapy Model

0 to 1

Brainstem

State Regulation

Core Arousal

Focus Attention

Postural Regulation

Motor Learning

Equilibrium/ Coordination/

Timing

Metabolic/ ANS Irregularities

Adult to Child1 to 1

No Play Therapy Model Fits well here.

Interventions are nonverbal, sensory, movement, rhythmic, primary experiential, and relational.

Primary process and primitive sensory experiences dominate.

•Child Centered•Experiential Therapies•Filial Therapy•Developmental Play Therapy•Floor Time•TheraplayAll rights reserved © 2011 Rick Gaskill and The Child Trauma Academy

Brain Stem InterventionFunc Age

Develop Play

Important Dev Milestones

Treatment Components

0 to 1

Relates to others 1 to 1

Solitary play

Exploration of World by Physical Contact/ nonverbal

Sensory/Motor Play: Pokes, dumps, pulls, tastes, smells, stokes

•Regulation/Attention/ Engagement with Environment:

•Eye Contact•Mutual Gaze•Smiles•Seeks Physical Contact•Enjoys Interactive Games•Sensory Play•Enjoys Humor/Teasing•Demands Personal Attention•Performs for Audience•Seeks Attuned Relation.

1. Clam your self!2. Adults must be safe

island3. Create Positive

Attunement4. Calm the child5. Routine = Safety 6. Predictable

Environment7. Limit Stimuli: lights,

sound, people, movement

8. Eye contact9. Extended gaze10.Positive, nurturing

relationship11.Relational sensory,

movement activity at heart rate.


Importance of Ritual in Our Life

Rituals communicate unity in a relationship

The point of rituals is to create connectedness

Rituals create a sacred place for unity in a relationship

Rituals are calming and sooth lower brain levels

The glue that holds relationships together


Human Beings are Build Through Play (Stuart Brown, MD, 2009)

Play is a Complex, Primal Process

Promotes Survival Shapes our Brain Makes us Smarter Makes us more Adaptable Fosters Empathy Develops Social Skills Develops

Creativity/Innovation Fosters Problem Solving Fosters Coping/Calming/Self-

regulatory Skills


Brainstem Enhancements

Pacification (child’s sensory modality)

Rocking/Glider/ Swing/Holding

Touching / Stoking Massage/Wt Balls Grooming Cuddling/Hugs/Holding/

Snuggies Feeding “Motherese”

Lullabies / Songs Nursery Rhymes

Infant Games Games Fast/Slow and

Small/Large Movement

Sensory Stimulation Sand / Clay Play Shaving Cream Making Cookies Songs/Stories/Nature

Sounds Smelling for Identification Texture Bags for Touch

Sensations Tastes for Fun,

Identification Looking at

Pictures/Paintings


Enhancements for Grade School and Above

Sensory Stimulation Sand, clay, play dough Pottery making Sculpting with clay Finger foods Songs, stories, musical Pictures, Scent identification Paintings, coloring, Water play, slides, fights

Healing Touch Massage (hand, fingers, foot) Reiki Touch Pressure Points Showing concern for

injuries/hurts Grooming

Nail manicure/painting Hair Brushing/Braiding

Rituals/Routines that say nothing has changed in our relationship Uniting; Connecting Closing

Songs, chants, activities Connecting

Nick Names Names of endearment Hand Sakes/High Fives

Commitment Manners as a

demonstration of respect Celebrations (birthdays,

graduations



Attunement/Relaxing/ Calming: Listening to music Singing Listening to natural

sounds (wind, rain, crickets)

White noise Reading to the child

Dr Seuss Poetry

Rhyming Relaxation Exercises Progressive Muscle

Relaxation Breathing Exercises Autogenic Phrases Guided Imagery Swimming Yoga Marshal Arts Drumming Bathing with bubbles, bath

salts etc Massage chairs/pads


Possible History of Problems (Vegetative Regulation, Control/Sequencing of

Motor/Balance)

Primary Sensory Perception/Organization

Arousal/ Rapid HR/ Tense Muscle Tone

Poor Coordination/ Balance/Rhythm/Clumsy

Dissociative/Pseudo-seizures/ Cutting/ Burning

Focusing, Shifting AttenMaintain Homeostasis

MemoryRemains in solitary playSleep/Wake Regulation/

Nightmares/Waking at night

Appetite/Feeding/EatingNeuroendrocrine Reg

Hypothalamic: / Stess Hormones/ Growth, Menses, Loss of hair, Sexual development


Important Treatment Concepts

Age Brain Area Dev Goals

Dev Social Ratio

Play Therapy Model

1 to 2

Diencephalon

Sensory Percep

Coordination of Motor/ Balance

Functions

Sleep /Wake Cycle

Regulation of Need/Drive

Func

ANS Functions and Homeostasis

Adult to Child

1 to 1

Later

1 to 1 to 1

No Play Therapy Model Fits well here.Interventions Still nonverbal, sensory, movement, rhythmic, primary experiential, and relational.

Primary process and primitive sensory experiences dominate.

•Child Centered•Experiential Therapies•Filial Therapy•Developmental Play Therapy•Floor Time•Theraplay

Gaskill & CTA, 2008


Diencephalon InterventionAge Developmental

PlayDevelopmental

MilestonesTreatment Components

1 to 2

Relates mostly 1 to 1

Solitary Play, later likes to be near others

Egocentric

Little empathy/sharing

Need for Autonomy

Poor Emotional Reg

Tantrums Short Atten Span

Purposeful Gestures to Communicate

Fantasy/ Pretend Play

Lots of Gross Motor Play

Holographic to Telegraphic speech

Likes constructive play toys

Language Skills

1. Adults must be calm

2. Create Attunement

3. Grant Autonomy When Can

4. Let the Child Lead

5. Activity and Exercise

6. Rhythm, Strong Beat

7. Motor/Movement

8. Arts Crafts Manipulative

9. Give Voice Nonverbal Cues

10. Attempt to extend Play


Reading and Narrative Story Telling

Stories are the archetypal way we understand.

Explains HOW the world works.

Even judgments of right and wrong are understood as part of story about events that happened.

Helps form Gestalts, sequence events, and construct a reasonable representation of reality.


Diencephalon Enhancements

Sleep Hygiene Consistent Bed time routine Go to bed and get up at the same

time Quiet time 30 minutes before bed

time. No TV to put to sleep No scary movies

Eating/Feeding (social event) Finger foods Try different textures/flavors Rice Krispy Hands Cooking together Tea party

Gross Motor: (Phys Exercise) Crawl through boxes, tubes,

mazes/follow a treasure map Fast/Slow/Small/Large Hula Hoops Balls/Bean Bags Swimming (Simon Says: Duck, Duck Goose Trampoline/Balance Discs Brain Gym Bal-A-Vis-X Hand Clapping games Jump Rope/Jumping Balls Play Ground Equipment



Fine Motor Lego's/Constucts/Dominos Puzzles Tidily Winks Hop Scotch Building Blocks Stringing macaroni/popcorn Crafts/Jewelry Making Fingernail Paining Pick Up Sticks/Jacks/Marbles Bop IT Jenga Operation Perfection Blowing Bubbles/Cotton/Ping

Pong Balls back and forth

Music/Dance/Movement Music Chanting Rhyming Poems Nursery Rhymes Rhythm Bands Reading / Telling Stories (Dr. Seuss) Drum Circles Line Dances/YMCA Yoga Tae Kwon Do Tai Chi


Diencephalon Enhancements

Simple Narrative Recall experiences Show and Tell Read Stories/Poetry I Love You Rituals Books/Pictures/

Manipulative


Possible History of Difficulty Social Relationships, Attunement, Affect Regulation and Pleasure

Emotions Poorly Regulated

Difficulty Understanding Emotions (self and others)

Poor Social/Emotional Recognition/ Interpretation

Problems with Stress Neurotransmitters

Emotional Learning/Memory

Poor Attachments to others

Lack of EmpathyPoor Social SkillsTrouble Sharing Trouble Taking TurnsSeldom Seeks

Emotional Closeness from Caregiver


Possible History of Difficulty Social Relationships, Attunement, Affect Regulation and

Pleasure

Fear Memory (Freezing, Tachycardia, Respiration, Stress Hormones)

Poor Memory/Learning

Poor Spatial Navigation (poor internal compass)

May Lack Motivation

Poorly Engaged in Social, Pretend

Dramatic Play May Lack Appropriate Social Content

Ability to Respond to Positive and Negative Stimuli


Possible History of Difficulty Social Relationships, Attunement, Affect Regulation and

Pleasure

Few words Symbols to share feelings

Needs support to play with others

Antidepressants and Psychotherapy may increase the size of the Amygdala

Inhibitory influence on motor systems (Behavioral Control)

Reward/Pleasure and Learning

Assoc with Mental Disorders Anxiety Disorders OCD PTSD Separation Disorders Borderline Personality Social Phobias Depression Binge Drinking Addiction to Drugs


Important Treatment Concepts

Age Brain Area

Developmental Goals

Develop Social Ratio

Play Therapy Model

1 to 4 Limbic

Processing Social Information

Affect Mood Regulation

Play/Pleasure

Attunement/Attachment

Consolidation of STM to LTM

Spatial Navigation

Adult to Child

1 to 1 to 3

To

2 to 1 to 5/6

Feeling and Affective modalities. Includes: language, relationally and experientially based tech.

Logical, rational, or conceptual models are contraindicated.

Begin with parallel play with adult to parallel play with child.

Individual/Family TX:Child Centered, Relationship, Filial, Adlerian, Directive, Tech, Theraplay, Experiential, Sand Tray, Developmental PT, Art, Psychodrama

Limbic InterventionAge Developmental

PlayDev Soc Milestones Treatment Components

1 to 4

Enjoy Social Play

Simple Interactive Play with others

Can be played with rather than managed

Generally Cooperative

Responds to Praise

Concerned with what is “right”

Shows Purpose to Play and Motivation

Emerging Regulation of Emotion

Holographic, to Telegraphic to Complete Sentences by 3

Toilet Trained

Pretend Play to Dramatic Play

Enjoys playing with peers

Mastery Play Begins

Able to Take Turns and Share

Using words for feelings

1. Stay Calm

2. Maintain Positive Relationship

3. Reflect Feelings in self and others

4. Use Calming Strategies

5. Improve verbal literacy

6. Let the Child Lead Play

7. Support Mastery Play

8. Use Many Positive Statements (Credit)

9. Use Expressive Media


Nature Discovery/Play

Helps construct a model of how the world works

Bases for abstract/mathematical /scientific learning later

Decreases ADHD BehaviorStimulates Neural Growth

HormoneTeaches Problem SolvingStimulates All Senses and Calms,

Regulates


Limbic Enhancements Social Skills Games/ Activities Sharing Games Classroom Chores Classroom family Rituals

Greeting/parting/calming/connecting

Nick names/pet names/symbols of regard

Look at Facial Expressions in the Mirror

Study Pictures in Magazines Social Group Rituals

(handshakes, songs, greetings) Therapy Dogs (empathy gentle

touch) Nature Discovery Natural Obj (shells/nests/rocks)

Traditional Play Therapies

Art / Drawing / Painting Finger painting Sculpture Paper Mache Crafts for Creative

Expression

Little Plays / Dramas Pretend Play/Dramatic Play Give and follow directions Play Hid and Seek Games of cooperation Creative Dance, Movement


Enhancements For Grade School and Above

Emotional learning Build what is described

to you with Legos Use terms of

up/down/behind/under to have others draw what you describe

Create Mazes from boxes, sheets or in a garden

Make a compass course and follow it.

Make a treasure map to find hidden candy or prize

Have a scavenger huntPuzzles to solve of

wood/metalCard Tricks/Magic Tricks


Games: Sorry Bingo Ungame Talking, Thinking, Doing

Game Attitude Adjustment Life Battle Ship Trouble

Complex Narative Books Stories Social Issues Aesop’s Fables

Enhancements For Grade School and Above

Aesop’s FablesRead Stories about social

skillsBooks, PoetryTherapeutic MetaphorsPuppet shows

Family, School, Group Rituals Birthdays Anniversaries

Therapy Dogs/HorsesGroom and care for

Cats/Puppies/AnimalsDramatic Play

Memory Games Concentration Old Maid Hearts Memory Simon Says

Children’s Games Duck Duck Goose Simon Says Red Light Green Light Musical Chairs Candy Land/Flower

GardenAll rights reserved © 2011 Rick Gaskill and The Child Trauma Academy

Possible History of Difficulty(Thinking, Creativity, Problem Solving, Self-

Image)

Sensory integration problems

Can’t Delay GratificationUnable to express

thoughts, wants, likes etc

Trouble with Cooperative Play

Dramatic Play Doesn’t Makes Sense

Logical sequences in conversation

Poor self-awareness/self-image

Difficulty with cause effect thinking

Unable to plan and problem solve.

Academic skill problemsPoor insight, abstractionUnderdeveloped moral

thinking, ethics, concern for others


Important Treatment ConceptsAge Brain

AreaDevelopmental

GoalsDevelop Social Ratio

Play Therapy Model

2 to Teen

s

Cortex

Abstract Cognition, Thinking, Reasoning, Planning, Problem Solving, Insight, Foresight.

Complex Learning, Memory, Sensory Integration

Orientation in Time an Space

Language Development

Social/Emotional Competency

Adult to Child

3 to 1 to 5/6

All Play Therapy Modalities are now available (processing experiences verbally, creatively, emotionally & cognitively .

CBT, RETDirective TechniquesGame PlayPsychodramaArt, Sand Tray, MusicAdlerianChild CenteredExperientialGestaltPsychodynamic TheraplayBibliotherapyIndividual, Group, Family


Cortex InterventionAge Developmental

PlayDevelopmental

Social Milestones Treatment Components

2 to Teens

Parallel to cooperative play

Play with peers, less dependence on adults

Play moves to mastery play and latency age play,Industrious

More competitive play (sports/games)

Gender Specific Play is more Obvious

May take risks, show off, seek recognition

Less Egocentric

Intellectual Skills Grow Rapidly, Their Arguments are More Reasoned

Join Groups/Clubs

More Aware of Social Norms /Rules/Fairness

Take Pride in doing things themselves

Develop Interest in Sexuality

1. Maintain Supportive Relationship

2. Give Positive Feedback

3. Recognize the Child’s Unique Qualities

4. Engage in Pretend Play

5. Play Cooperative Games

6. Play Competitive Games

7. Use Creative/Expressive Mediums

8. Help Solve Problems

9. Discuss Values/Beliefs


Remember: Use Dependent Brain

How two brains interact determines the strength of the neural connections through which we feel our feelings and form bonds with each other


Cortex Enhancements(use as age appropriate)

Bibliotherapy Stories with a lesson

Aesop’s Fables Annie's Stories Therapeutic Metaphors Story telling about moral

issues/character Jokes/humor Cartoons/humorous art, characters

Conversations about things of interest to the child

Performing/Creative Arts Musical expression Dance Art expression Writing

Field trips to see visual and performing arts, with discussion of the experience

Role play abstract themes Love, justice, jealousy, loyalty, morality

Use puppet, animals, toy people to illustrate experiences

Logical Problem Solving Riddles Logic problems 20 Questions Who or What am I I am Thinking of an Animal Guess Who What’s missing

Problem Solving Puzzles Paper Mazes Bent Nail Puzzles Toys that can be taken apart and

assembled Physical games and sports

Teach Strategy Teach Character Team Building Team Work Winning/Losing


Cortex Enhancements Games

Charades Clue Master Mind Pictionary Junior Scruples Guess Who Connect Four Pick-up-Sticks Sorry Aggravation Checkers Chess Spades Old Maid Battle Ship Mine Sweeper Uno Trouble Dominos Memory Go Fish I Doubt It

Social Skills Training Boys Town Program Conscious Discipline PATHS Incredible Years Programs

Social Skills Games Angry Monster Machine Family Happenings Control Patrol Mountaineering Self-Esteem Game Social Security Ungame

Cultural Appreciation Books Pictures Museums Cultural Centers Speakers


Thank You

Go forth and do such good works as you have been

called to do.


Neurobiologically Guided Play Therapy

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