Guest blog by Geraldine Thomas
As play therapists we play an important role in children’s lives. When this role becomes abruptly restricted because of circumstances such as the sudden imposed constraints on face to face meetings during the recent Covid-19 outbreak it is not surprising that many amongst us will have felt the need to keep providing therapy come-what-may. Initiatives to accomplish this were quickly promoted and eagerly undertaken. Some of these challenged the accepted values of the therapeutic relationship in the safety and security of the confidential playroom space. So when crisis situations like those today motivate therapists to spring into action to ensure their much valued place in the child’s life can continue, I would like to think about whether some of the options offered, tele-play therapy amongst them, are really in the child’s interest.
In less crisis-driven circumstances, we always carefully assess the conditions in the child’s life to evaluate if family conditions are too uncertain and unpredictable for the child to truly benefit from therapy. Being in the midst of court proceedings, family breakdown, foster care disruption, recent adoptive placements are but a few. In these conditions we ask, “Is this the moment? Are the conditions stable enough? Is the timing right?” Occasionally, under pressure we will undertake this work regardless of less than optimal conditions to offer a place where the child can emotionally be held as no one else is available to do this. The absence of others to ‘hold’ the child, however, is what prompts such emergency driven practice. Environmental stress and family tensions now create conditions for children that are not dissimilar to those mentioned above when the child is not able to optimally relax enough to benefit from therapy.
Play as therapy is a multi-sensory experience that encompasses proprioceptive senses that soothe and regulate the nervous system. It fosters and promotes social connection, teaches relational roadmaps and becomes one of the major brain sources of joy.
This leads to an important question: In these conditions of pervasive uncertainty and familial stress, are children prepared for a significant shift in the way the therapist usually connects with them and where play no longer leads to the experience of containment and release, with the therapist no longer closely present to ensure the safety of all that is emotionally or physically explored?
I believe that the situation requires us to step back, wait, and endeavour to help conditions become stabilised by intervening in the environment in which children find themselves on a daily basis. This approach requires therapists to ask those who care for the children, and with whom the children have an attachment, to step up and do the important work that will be most important for their children. That work is the provision of a safe and secure environment in which the adult carer plays a key role in homeostatically regulating the child’s emotional factors in the face of altered conditions. Rather than see themselves as invaluable to the child, therapists can offer the parents strategies and management techniques along with empathic listening and carefully held boundaries to connect sensitively with their children and offer the relationship between them as a buffer against the unexpected difficulties the children and their families are experiencing.
The recognition of the parent-child relationship as the conduit through which emotional and behavioural regulation is offered is a necessity in these times when children are at home and the recipients of ongoing emotionally stressful transactions. When parents are directly able to help children improve their ability to cope with and regulate their feelings, those emotions that threaten to become overwhelming and too big to process alone can be contained and managed in a way that enhances and strengthens the parent-child relationship and the security of the attachments.
Rather than engaging the child in an altered therapeutic relationship, by “holding” the parents as well as empowering them to create an environment in which the child’s changing emotional states can be recognised, accepted and responded to sensitively, the therapist helps the home become a regulated, emotionally contained environment.
Therapists can also help parents create daily situations in which they can have fun and experience joy and release together. In this way the child comes to recognise, through daily experience, that the parent or carer is valuable in helping them achieve this regulation so that emotional experience, no matter how heightened, is always manageable.
Finally, there is more that happens in usual therapy than a therapist being available to a young client for ongoing contact and support. This has a role, too, but it, by itself, is not therapy. In therapy there is the deeply felt emotional experience of resonance of feelings and physical presence. There are deeply felt physical connections as mirrored in body language, tone of voice, and a deep conjoining of leading and following, of pace and of falling into step with and attuning, understanding, and accepting. These are felt experiences in the presence of the other.
In response to a Facebook thread, I wrote that I did not challenge the potential benefits of teletherapy, or for that matter any other approaches which may indeed offer an ongoing connection which current conditions now make inaccessible. Even so, unless parents are unable to regulate their own emotional climates and their family environments, children benefit more from having their home feel safe and secure, as a place where emotions can be managed by those they feel closest to. There are so many scary situations that children need to negotiate now that create anxiety. For some, having your therapist teleport him/herself into your home may add to that sense of anxiety and urgency. Until children have a chance to adjust to these moments of transition and adapt to the new reality it may not be the right moment for individual therapy. This can come later when they are ready to make those psychological shifts.
Therapy is of course predominantly about the relationship between therapist and child that offers a safe, confidential understanding of the child’s difficulties and creates the conditions available for change. It is a noble striving to want to perpetuate this relationship when children face increased stress. Lack of certainty about the duration of the disruption to the therapeutic relationship causes anxiety in both the child and the therapist. But the loss of nuance and emotional and physical resonance in televised sessions may threaten this relationship more. Facial expressions and body language will be edited by the angle of the camera and critical moments will be missed. The therapist on the other side of the camera lens may no longer be the attuned sensitive and receptive person experienced when the relationship was “real.”
There are many risks in distance therapy that challenge the true values of the play-based relationship. From my perspective, it is the parents who need to be held and empowered to feel that they are indeed, with the support of the therapist, able to reset the “temperature” at home and help their children feel contained, regulated, and emotionally held. Above all they should feel trusted to be able to do this work.
Geraldine Thomas MSc, MA is a Certified Filial Therapist and Instructor, a Play Therapist and Clinical Supervisor and consultant to Child and Family Services in London, UK.
She has written articles and journal chapters on Filial Therapy for forming therapeutic partnerships with parents to achieve interpersonal, intra-psychic and neuro-biological change, play therapy in schools and cultural challenges in play therapy. She is also co -author of the acclaimed book, Understanding Adult Attachment Style in Family Relationships.
© 2020, Family Enhancement & Play Therapy Center, Inc., Risë VanFleet, PhD, President, and author Geraldine Thomas. All rights reserved. Photo © 2014, 2020, Risë VanFleet. All rights reserved.