What Kind of Therapy Should We Use?

One of the questions I often hear is, “What KIND of therapy should we use to help our child?”  My answer is always, “I don’t know.”  (Real helpful, huh?)  The thing is, I don’t believe any ONE therapy will help.  Our kids’ “stuff” starts at different places and different ages.  Trauma that happens early (and often) is often much more difficult to treat therapeutically than trauma which happens when a child is older. 

When I started trying to sort through all the therapy options 4.5 years ago, it seemed everyone I knew was singing the praises of Beyond Consequences, Logic and Control (BCLC).  This method was started by Bryan Post (who calls himself “Dr.” but does not hold a doctoral degree from any accredited institution -- only an online and now defunct diploma mill, and who was disciplined by the state of Oklahoma in 2007) and Heather Forbes, LCSWC (who has distanced herself from Post and now runs BCLC without him).  I read all the BCLC books.  I read articles on Forbe’s website.  I learned techniques from other parents who’d attended her trainings.  However, some of the BCLC stuff was easily manipulated by my very smart kids.  Besides, my kids NEEDED to feel as though someone was in “control.”  They’d had to control too much in their lives, too early.  They needed the direction of an authoritative parent.  (Notice I did not use the word, “authoritarian.”  Authoritarian parenting results in rebellion and steps backward in the healing process.  Authoritative parenting lets the child know who is in charge, and gives them a sense of safety, consistency, and protection.  My kids need that.)  In short, BCLC had some things that worked, and some things that didn’t.

We have used a lot of play therapy and family therapy (and play therapy as family therapy).  These methods have helped a lot with attachment.  It is SO important to find a therapist who really knows about attachment and trauma.  Activities such as playing games and using sand trays have helped us find breakthroughs for both The Princess and Youngest Son.  For example, our therapist uses the game “Sorry” and adds some rules of her own.  If we get a “1,” we get out onto the board, but only if we say something good that’s happened since our last session.  If we get a “2,” we have to say something that concerns us.  If we get a “3” we have to say something that our family does together that we like, etc.  These games almost always never go on very long before our kids are working, without ever feeling (terribly) pressured to “go there.”  This method helps us deal with specific issues, using Interpersonal Therapy (IPT) methods.  It is the method by which I’ve learned the most in how to BE a therapeutic parent for my kids.

Cognitive Behavior Therapy is a very traditional therapy.  We use it a little bit, but only when things are going well.  When things hurt, and when a kid is dealing with trauma stored in the emotional part of their brain (amygdala), it’s nearly impossible to process things in the front part of their brain where cognition happens.  Still, it’s a therapy that has helped my kids feel as though they have some control over their lives -- when things are going well.

As I’ve written in earlier posts, for Youngest Son, Dialectical Behavioral Therapy (DBT) is the therapy that has changed his world (and ours).  However, this type of therapy would not have been possible with him even a year ago.  It is really just this school year that he’s matured enough, and has become stable enough on his medications, that he WANTS to change the way he responds to things.  Because DBT emphasizes responsibility for one’s own “stuff,” it was able to move him into a place where he could work cognitively and truly “own” his response to the things that trigger him.  It is only in recognizing that he DOES have PTSD, and that there ARE things that trigger him, that he is able to grasp hold of those triggers and change his behavior.

There are a lot of other things we’ve tried, as well, including “out-crazying the crazy.”  (Which is fun!)  We’ve even used (gasp!) traditional parenting methods in our therapeutic approach.  Like any of the above, sometimes it works and sometimes it doesn’t.  In my experience, raising hurt kids is a very fluid enterprise.

I found a PDF which may be helpful to some.  It describes various therapy methods in very basic terms and is a good introduction to the world of therapy.  You can find it HERE.  It might serve as a conversation starter when talking to a potential therapist for your family.  There are also lists of questions to ask available on various blogs and websites.  One good list is HERE.

Please feel free to share other ideas in the comments section.

Need to Control = Fear

The Princess and I had family therapy yesterday morning.  It wasn’t fun.  This is the second session in a row she has refused to participate.  She just sits there, with her arms folded, and won’t say anything other than, “I don’t know,” or “I don’t want to talk about it.”  There’s a lot going on, but for her, if she doesn’t think about it, then it’s not really happening.  For her, if she doesn’t deal with it, she doesn’t have to feel it.  For her, those big feelings are still there whether she wants to feel them or not.  So, because she will not deal with “it,” she is easily triggered and then explodes, (like she did at the zoo), or she’s constantly talking, bouncing off the walls, and using her baby voice.  You see, she MUST be in control.  If she lets go, if her control goes, then there’s no telling what feelings will come to the service!  She’s crazy scared of what those things REALLY feel like.  The fear is HUGE!

There is nothing we can do to MAKE her participate in therapy or in other community based services.  Nothing.  We can be there.  We can offer her support and help, but if she doesn’t want to participate, we’re (therapist, social worker, SRS case manager, parents) just spinning our wheels.  She’s just not ready for talk therapy right now.  She’s 13 and has the shape of a young woman, but she is still about as emotionally capable as a preschooler.  So, backwards we go.  In therapy, we’ll deal with the preschooler.

After the $140 waste of time yesterday morning, the Princess’ therapist called to talk with me privately.  We had two choices:  quit for now (not an option to me) or revert back to play therapy with puppets, sand trays, play dough, and other toys (like you’d use with a much younger child).  I asked the therapist to try taking her backwards and working with her as though she were in preschool.  When she started therapy two years ago, these are the kinds of tools we used in our attachment therapy.  She responded well then.  She revealed her thoughts and feelings through play and responded well to receiving ideas for helping her to deal with situations.  So now, in going back there, I am hoping she responds well again.  Things have been so hard with her the last several months.  I cannot imagine her (nor I) not having our therapist and HCBS (home & community-based services).  I don’t want to imagine it.  (I know some of you, dear readers, do not have a mental health facility near you like we do.  Please forgive my whining.  I know a lot of you do this on your own.  I am a wuss, and God knew that when He plunked us down here.  Believe it or not, I just “lucked into” finding our therapist.  I didn’t even know we had a MH facility in our community when we moved here.) 

When I picked The Princess up after school yesterday, I told her the therapist called me, and that we talked about adding a community-based service (someone who’d work with The Princess in the community and talk with her about family and social skills).  We also talked about the need to cooperate and work in therapy.  I explained we’d be going back to doing play therapy more so than talk therapy, but that she needed to do the work of dealing with the big feelings that have been bubbling up inside of her.  I did not tell her about the possibility of being “fired” from therapy for not cooperating.  She would seize CONTROL of THAT like a drowning man grabbing a life ring!  I did tell her if she did not cooperate, we would be facing a lot more years of therapy and interventions than we could begin to imagine.  (I did not elaborate.)

The Princess is not afraid of me, nor of her therapist.  That’s not where her need for control rests.  She trusts us.  The person she doesn’t trust is herself.  She doesn’t trust she’s strong enough to handle those big feelings that are festering under the surface.  She’s afraid of peeling off the emotional scab and letting whatever poison out that is there, so the healing can begin.  Alas, we plod on.  We try to help her feel safe enough to “go there,” assuring her that developing coping tools now, while she’s young, will help her out much more effectively than waiting till she’s older to deal with things and does not have us “right there” to catch her, and help her back up.

That’s what therapeutic parenting is, you know.  Plodding on.

Trauma sucks.  Big time.

Sandspiel (Sand Tray Play Therapy)

Most therapeutic parents I know are not psycho-therapists, nor registered play therapists, nor even social workers.  We’re just moms and dads raising hurt kids with traumatic pasts we will never fully know nor understand.  We’re just people trying to help our children live their best possible lives.  So when I write about sand tray therapy, please remember I’m presenting my experience and whatever knowledge I have as a layman – as “just” a mom.  There are plenty of places on the internet where you can find more scholarly articles and research-based information.  One place you might start to look for that information is sandplay.org.  The purpose of this blog is for sharing parent-to-parent, not to serve as therapist.  So, that’s my not-very-legal-sounding disclaimer before I begin.

Sandspiel (or sand play) therapy was developed by a Swiss therapist named Dora Kalff (1904-1990).  There is some argument about whether or not she is the originator of sand play (or sand tray) therapy.  Some people say H.G. Wells was the inspiration for it because he wrote about his two young sons using miniature toy figures to work out problems with each other and with other family members.  Frankly, I don’t care who originated it.  I know Kalff wrote about it first and then other therapists expanded upon it.  It boils down to using a tray, filled with sand and usually, a bunch of different kinds of small toy figures to make pictures in that sand.  (Sometimes, it’s just drawing in the sand.)

Sand tray therapy is a specific kind of play therapy where the therapist (or therapeutic parent) sits close by and seemingly does nothing while the child uses sand to make a picture.  Sometimes, the person observing the play will give some open-ended direction such as, “Make a picture that shows how you’re feeling.”  Other times, the direction may be more pointed, but still rather open-ended.  For example, the first time our therapist pulled out her sand tray, she drew a line down the middle of it with her finger.  She directed my son (then 14) to “Make two pictures in the sand.  One of your life before your adoption, and one of your life with your family now.”  (Notice she left the part “before your adoption” open-ended.  She didn’t tell him to make a picture of his family before adoption, or of his orphanage life before adoption.  She left that up to him.)   Still, other times, there may be no more direction except to “Make a picture in the sand.”


People have been making pictures in the sand throughout history.  The Bible talks about Jesus “drawing (or writing) in the sand” when the Pharisees questioned him about a woman caught in adultery (John 8).  In Navaho Symbols of Healing, Donald Sander writes about sand painting ceremonies.  When the ceremony is over, the painting is wiped away.  Today, Zen Sand Gardens are popular gifts and people of all religions (or no religion) enjoy making designs in the sand as a relaxing “de-stressor.”  The thing that is common for all of these is the non-verbal imagery of the activity.  Jesus was silent as he drew in the sand.  The Navaho ceremony is conducted in silence.  People play in their desk-top sand gardens in quiet solitude.  Thoughts are processed in the silence while the sand provides a tactile experience or outlet for those thoughts.

As a parent, you can discern a lot about what’s going on with your child by watching him work through a sand tray picture.  Does the picture have people?  What about dinosaurs or other monsters?  What about super heroes?  Animals?  Fences?  Houses?  Is there violence in the picture?  (Crashed cars, fights, etc.)  Is there conflict of emotion?  (Domestic scene with mom walking away?)  Granted, as a parent, we might not be able to figure out everything exactly as our child is thinking it, but we can get a good idea.  When he’s done, asking an open-ended question such as, “Tell me about your picture,” will provide him an opportunity to make things more clear for your interpretation.  When he’s finished, if you’d like and if he’s receptive to it, you might add what you see.  For example, “Wow.  It looks to me like these guys are really upset with one another -- like maybe they want to kill each other.”  Or “This mom looks peaceful to me and her kids look like they are happy.”

For our family, the sand tray has provided an opportunity for me to redirect a child,  to stop the crazies so we can focus on something else, and to help my child get the big feelings stored in that center, emotional part of his brain where there are no words (the Amygdala) to the front part of his brain (the Neocortex) where he can process those feelings with words and rationalization.

Well, at least that’s the goal.  Granted, we don't always get to rationalization because hurt kids aren’t always able to process big feeling with words and rationalization.  Still, even when our kids can’t process those big feelings, the sand tray gives us an opportunity to verbalize what we see going on in their picture which is a snapshot of what is going on in their brain.

You might say something like, “This mom looks peaceful to me and her kids look like they're happy.  I know I want to be peaceful and I want my kids to be happy.”  Or, “They look like they want to kill each other.  That makes me wonder if they’re really angry about something that happened, or maybe if something bad already happened and they’re remembering how they were scared.”  When our kids CAN’T tell us about their sand picture, cues from a therapeutic parent can sometimes help them “get there.” Even if they end up saying, “NO!  That’s not what’s happening!,” we've still helped them begin to process.  In that case, we can say, “Oh, okay.  So, tell me what they’re really doing.”

While the child is involved in the work of making the picture, the parent does nothing but observe.  Answer any questions your child has with an open answer.  Ask, “What do you think?,” without giving your own opinion, as a way for your child to explore even more.  For our son, wanting to KNOW THE ANSWER was a big, stress-filled motivator for him.  Open-ended stuff like sand trays drove him batty at first because he needed to know the rules.  If there was any question, he didn’t want to appear as though he didn’t know the answer – the RIGHT answer.  It was freeing for him, though it was not without struggle, to get to a point where he realized that sometimes, there are no “right” answers.  Sometimes, things just “are.”  And sometimes, things can’t be fixed or righted.  However, we can process those things, move on, and try to learn some skills to help us navigate through life, maybe adapting those broken things so that they have a new purpose.