Solution Focused Play Therapy with Children and Families

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Solution Focused Play

Therapy with Children

and Families

AAMFT Annual Conference October 2013

Pamela King, M.S. Amber Willis, PhD Darryl Haslam, PhD

Workshop Overview

I. Philosophy and Assumptions of Solution- Focused Brief Therapy (SFBT)

II. Debunking Myths of SFBT III. Play Therapy and Families IV. Debunking Myths of Play Therapy V. Empirical Support for Play Therapy VI. Demonstration of Solution-Focused Play Therapy with Families

VII. Role-play/Case Scenarios

Solution-Focused Brief Therapy

Key Figures

:

Steve deShazer & Insoo Kim Berg

Overview of Theory:

– Emphasis on solutions, instead of problems • Focus on solutions in session, not on problem • Problems = Unsuccessful solutions

Post-Modern Roots:

• Collaborative therapeutic role

• Emphasis on “languaging” and planting suggestions • Client self-determination and problem definition

Solution-Focused Brief Therapy

Principles about Problems and Change:

– People are constrained by narrow, pessimistic attitudes about life and self

• They get saturated by problems and can’t see solutions to them

• Must open their minds to new possibilities – Change is inevitable in life and in families, so

small, meaningful changes are effective – Language: Focus on how people talk about

problems

• “Language creates reality.” (DeShazer)

Solution-Focused Brief Therapy

Key Aspects:

1) Future-focused: Little emphasis on past issues - Don’t need to know much about problem to solve it - Addressing what people want vs. what’s wrong

2) Resistance: Rejection of the idea of “resistance” -Humanistic roots: Client/family motivation and

ability to change

-Post-Mod: Resistance= “Wrong way” in tx focus 3) Time-limited: Designed as a brief therapy - Focus on small but meaningful changes in “client system”

Solution-Focused Brief Therapy

Over-Arching Goal in Therapy:

– Switching from “problem talk” to “solution talk”

• Clients are encouraged to steer from “problem talk” to “solution talk”

– “What would Mom see you doing to say it’s going better?”

• Therapist helps client reframe their issues via languaging them differently

– “It sounds like cares about you a lot to be so concerned.”

Key Focus in Sessions:

– Talk about potential solutions instead of about past problems and empowering clients to see solutions

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Solution-Focused Brief Therapy

Specific Aspects of Goals in Session:

– Focus on presenting complaints • Brief therapy metaphor of “Mechanic

Repairs”

– Emphasis on helping clients think or do something differently

• State goals in positive terms: “More . . .” – Goal clarification is a central activity and a

dynamic, continual process during therapy • Not a one-time or static process

Solution-Focused Brief Therapy

Goal Setting in Session:

– Help clients translate big goals into attainable objectives and determine how would they be measured

– Help establish concrete measurable indicators of their progress

• Often in terms of behavior or actions that reflect mood or thinking changes

Collaborative Goal Setting:

– Mom & D Build Together

Application with Children:

Goal Setting Assumptions

SF Assumptions in Systems & Play

– Families/Children are Unique, – Parents Play Important Role – Parents Want Child to be Well – Children are Amazingly Creative – Activities/Toys are Conversational Tools (rather than diagnostic)

Solution-Focused Brief Therapy

(core assumptions cont.)

Aspects of Therapeutic Change Process:

1) Help clients shift from talking about problems to talking about solutions 2) Help clients find and/or recognize unseen

solutions to problems

• Help the client recognize times they were already making the problem go away (i.e., Wizard of Oz)

3) Then, get them to do more of these solving actions (will reinforce further changes)

Solution-Focused Brief Therapy

Steps in Therapy:

1) Assess client system’s readiness to change 2) Find exceptions to the Problem:

• Assess for possible solutions that may already be present. Examples:

– “What is going on when it is different?” – “What are you doing or thinking when

things are better?” “What would others notice about you?”

– “What will change for more of this to happen?”

Solution-Focused Brief Therapy

Steps of Therapy: (cont.)

3)

Plant seeds of change and hope via carefully-worded phrases or suggestions

• Amplify exceptions to help clients feel like solutions are possible

4) Instill a Vision:

• Help clients imagine and discuss what their lives “will” be like “when” things were better • Be specific in behavioral or cognitive terms

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Solution-Focused Brief Therapy

Examples of Validation Statements:

– “What have you done to make the problem less or go away?”

– “How have you done as well as you have, given all that you’ve been through?”

– “Wow, you must be a strong person . . .” – “Look at how much you’ve survived . . .” – “What things have you done well . . .?”

Solution-Focused Brief Therapy

Key Interventions/Techniques:

1) “So-if” questions:

• “So, when[that issue/problem] is better, will it solve your problems?”

2) Scaling Questions:

• “On a 1 to 10 scale, how would you rate your sense of hope in life right now? When we’re done?”

3) Reframing (same as other models)

Solution-Focused Brief Therapy

Interventions/Techniques:

4) The “Miracle Question”

• “If you woke up tomorrow and a miracle happened, and your key problems were gone, what will be different about the way you act, feel and think?”

– Be detailed in behavioral descriptions – Variations: “Magic wand” or “three wishes”

5) Formula first session task:

• Ask clients to observe over the next week what things are going well (or they want to continue)

Application with Children:

“Future Play” Interventions

• Preferred Futures

– Importance of Role Play – Experiencing ‘Better’ – Getting Details

• Shrinking Fear Ball

• Angry to Calm

Debunking Myths in SFBT

Problem Phobic or Solution Forced

Clients need to be highly motivated

SF is

effective with difficult clients/ cases

• Sexual Abuse (Yvonne Dolan) • Child Welfare Family Services (Berg) • Suicidality (Fiske)

• Substance Abuse (Pichot, Smock)(Berg, Miller) • Is accepted as evidence-based practice

– SAMHSA, NREPP, & OJJDP

What is Play Therapy?

Play Therapy:

– Originated in early 1900s

– Incorporates toys/play materials to help children express thoughts & feelings, preferred futures

– Toys are a conversational tool in SF – Draws on creative art, puppet/doll,

psychodrama, games, and sandtray activities

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Debunking Myths of Play Therapy

• Play Therapy (PT) is just “playing with toys” • PT is a theoretical orientation

• PT is a “voodoo” approach without clear theories, interpretations or research • PT is a new thing or a “therapeutic fad” • Play-related techniques cannot be used in

adult or family therapies

• PT set-up is too costly to be practical

Play Therapy and Families

Perceptions About Play Therapy:

– Play therapists often focus heavily on working with the child in therapy

– Family therapists often focus on families in child-focused cases

– Both groups have often maintained a perception that play therapy is mostly just for children

• This attitude limits how play therapy can be used with families and in situations where adults or teens are present

Haslam & Harris, 2011

Family Play Therapy

Family Play Therapy (FPT) balances:

– The use of developmentally appropriate methods with children and a clinical focus on the family system

- FPT gives the family therapist effective techniques for engaging children

- FPT evokes the family’s creativity & spontaneity “The integration of play with family therapy

strengthens both therapeutic approaches”

– Eliana Gil (1994)

Family Play Therapy

Benefits of using FPT:

– Engages all family members, giving children meaningful ways of being involved

– Reveals the family’s dynamics in powerful ways – Utilizes healing properties of play and diffuses

anxiety

– Creates powerful symbols and meanings for families

– Allows the family to share in the problem and its solution

Gil, 1994; Lund et al., 2002; Sori, 2006

Family Play Therapy

Empirical support for PT and FPT

– PT shown to be effective with diverse age range of children w/variety of clinical problems – Tx effects similar to non-play child tx

• (e.g., CBT methods)

– Most powerful effects found when parent is conjointly involved in child’s tx

– FPT associated with

• Greater child participation

• Improved quality of child-therapist alliance • More positive emotional experiences

LeBlanc & Ritchie, 2001; Ray & Bratton, 2010; Willis, Walters, & Crane (in press)

Solution-Focused Play Therapy:

Bringing Miracles to Life

• Scaling Tools

– Abicus, ladders – Checkers

– Marbles, steps on the floor

• Video Examples

– Counting to Calm – Hopscotch Scaling – 10 Footsteps/Race – Sandtray “War and Peace”

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E.A.R.S.

A Solution-Focused Guideline and Tool for Practitioners

Elicit –

Ask about positive change

.

Amplify –

Ask for details about positive change.

Reinforce –

Make sure the client notices and values positive change.

Start Again –

Go back to the beginning and focus on client-generated change. Adapted from DeJong and Berg, 1998

Solution-Focused Play Therapy:

What’s Better

Second Session and Beyond

– E.A.R.S.

– What has gone well?

– What is better, even a little bit? – Examples

• Angry to Calm: Thinking • The Right Track • Earn a Chip: Play a Game • Self Esteem Chains

Solution-Focused Play Therapy:

Additional Interventions

Ending Treatment

– Review how child made changes – Family Collage

• Of the “new family” they’ve become • Accomplishments made over therapy • Positive things family wants to be doing in

future

– Graduation Celebration: Thank You Cards

Contact Info

Pamela King, M.S.

Pam@LifeDirectionsCoaching.com

Amber Willis, PhD

willis.amber.b@gmail.com

Darryl Haslam, PhD

DHaslam@MissouriState.edu

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Suggested Readings/References

Axline, V. (1947).

Play therapy.

Cambridge, MA: Houghton Mifflin.

Berg, I. (1994).

Family Based Services.

New York: W.W. Norton & Company.

Berg, I. & Dolan, Y. (2001).

Tales of Solutions.

New York: W.W. Norton & Company.

Berg, I. & Miller, S. (1992).

Working With the Problem Drinker.

New York: W.W. Norton & Company.

Berg, I. & Steiner T. (2003).

Children’s Solution Work.

New York: W.W. Norton & Company.

Bratton, S., Ray, D., Rhines, T., & Jones, L. (2005). The efficacy of play therapy with children: A meta-

analytic review of treatment outcomes.

Professional Psychology: Research & Practice, 36

(4), 376-390.

Brewer, A. L. (2010). Thank-you cards. In L. Lowenstein (Ed.),

Creative family therapy techniques

(pp. 301-

303). Canada: Champion Press.

Budman, S., Hoyt, M. & Friedman (1992).

The First Session in Brief Therapy.

New York: Guilford Press.

Cade, B. & O’Hanlon, W. (1993).

A Brief Guide to Brief Therapy.

New York: W.W. Norton & Company.

Dolan, Y. (1998, 2000).

One Small Step-Moving Beyond Trauma and Therapy to a Life of Joy.

Nebraska:

Authors Choice Press

Dolan, Y. (1991).

Resolving Sexual Abuse.

New York: W.W. Norton & Company.

Fiske, H. (2008).

Hope in Action: Solution-Focused Conversations About Suicide

.

New York: Routledge.

Freud, A. (1946).

The psycho-analytic treatment of children.

London: Imago.

George, E., Iveson, C., Ratner, H., & Shennan, G. (2009). Briefer-

A Solution Focused Practice Manual

.

London, UK.

Gil, E. (1994).

Play in family therapy.

New York: Guilford Press.

Gil, E. (2000). Engaging families in therapeutic play. In C. E. Beverly (Ed.),

Children in therapy: Using family

as a resource.

New York: W.W. Norton & Co.

Haslam, D. R., & Harris, S. M. (2011). Integrating play and family therapy methods: A survey of play

therapists’ attitudes in the field.

International Journal of Play Therapy, 20

(2), 51-65.20

Landreth, G. L. (2012).

Play therapy: the art of the relationship

(3rd ed). New York: Routledge.

LeBlanc, M. & Ritchie, M. (2001). A meta-analysis of play therapy outcomes.

Counselling Psychology

Quarterly, 14

(2),

149-163.

Lipchik, E. (2002).

Beyond Technique In Solution-Focused Therapy

. New York: Guilford Press.

Lund, L. K., Zimmerman, T. S., & Haddock, S. A. (2002). The theory, structure, and techniques for the

inclusion of children in family therapy: A literature review.

JMFT, 28

(4),

445-454.

Metcalf, L. (1997).

Parenting Toward Solutions.

Prentice-Hall, Inc.

Perkins, S., & Dolbin-MacNab, M. L. (2008). The toolbox: Using a collage to access client strengths. In C. F.

Sori & L. L. Hecker (Eds),

The therapist’s notebook,

vol 3: More homework, handouts, and activities for use in

psychotherapy (pp. 187-194). New York, NY: Routledge/Taylor & Franscis Group.

Pichot, T. & Smock, S (2009).

Solution Focused Substance Abuse Treatment.

New York: Routledge.

Ratner, H., George, E. & Iveson, C. (2012).

Solution Focused Brief Therapy.

New York: Routledge.

Schaefer, C. E., & Drewes, A. A. (2011). The therapeutic powers of play and play therapy. In C.E. Schaefer’s

(Eds.),

Foundations of play therapy

(2nd ed; pp. 15-25). New Jersey: Wiley.

Schaefer, C. E., & O'Connor, K. J. (1983).

Handbook of play therapy.

New York: Wiley.

Selekman, M. (2005).

Pathways to Change

. New York: Guilford Press.

Selekman, M. (1997).

Solution-Focused Therapy with children: Harnessing family strengths for systemic

change

. New York: Guilford Press.

Shapiro, L. (1996).

The Teens’ Solutions Workbook.

A Brand of the Guidance Group.

Sori, C. F. (2006).

Engaging children in family therapy: Creative approaches to integrating

Ray, D., & Bratton, S. (2010). What the research shows about play therapy: Twenty-first century update. In J.

Baggerly, D. Ray, & S. Bratton (Eds),

Child-centered play therapy research: The evidence base for effective

practice

(pp. 3-33). New Jersey: Wiley & Sons.

VanFleet, R., Ryan, S.D., & Smith, S. (2005). A critical review of filial therapy interventions. In L.

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