Multi-Modal Play Therapy: Background and Application


Topics Covered: Integrative Play Therapy tips and background, as well as how to incorporate the model into your practice in both ideal and less-than-ideal settings.  Length:  1 hour, 15 minutes, 42 seconds



Class Notes


About Leslie Baker

Leslie Baker, LMFT lives and practices in Pleasanton, California where she teaches and specializes in Integrative Play Therapy; she is also a Certified Gottman Therapist.

KEY TAKEAWAYS

Background of Integrative Play Therapy

  • Integrative Play Therapy is a combination of multiple theoretical orientations. There are many greats who developed play therapy, and there are several types of play therapy, such as sand play. Sand tray play is only one intervention in play therapy. Play therapy is supported through the Association for Play Therapy, which is an association of therapists who use many modalities of play for the treatment of children’s issues.

  • Play therapy is powerful, because it utilizes the child’s language of play to help them communicate their trauma story.

  • Within the Association for Play Therapy, which is a national organization, you learn the theories behind play therapy, how to witness and how to support, as well as how to use different types of play, including sand play,  expressive arts, and drama play (which is different than drama therapy.) When different modalities are incorporated in play therapy, it is multi-modal; this includes ranges between directive and non-directive, as well as a combination of philosophies that inform the modalities.

  • Lazarus was a theorist that believed you didn’t need to integrate philosophy or theoretical orientation. He believed that you could use any tool from any theory and put it in your “tool kit.” Leslie believes that you need to have the philosophical underpinnings underneath your work to make sure what you’re doing makes sense.

  • Leslie explains the development of therapy theories as based in the traditional philosophies of Kant and Locke.

  • Paul Wachtel combined the theories of psychodynamic theory with behavioral theory. Philosophically, behavioral theory and psychodynamic theory share philosophy. When Wachtel combined those theories, they matched the philosophy of Locke.

  • Behaviorism breaks things down to the smallest behavior. Psychodynamics, breaks things down to the smallest impulse.

  • Knowing where you stand in terms of background and having a grounded base can help you clinically assess and determine how to intervene in order to develop a good treatment plan.

Combining Approaches + Authenticity

  • Many therapists are eclectic, which can become a problem, because it may result in using an intervention that is not authentic or true to the therapist--how he/she thinks and feels about what makes change. This can result in less than ideal therapeutic outcomes.

  • In her office, Leslie integrates research-based methods with expressive play therapy modality and her Gottman training in her work with couples that need more hands-on, tactile learning. Using a sand tray works well with Gottman concepts, but, it’s important to note that using sand tray within couples’ therapy is not part of a Gottman approach.

  • It is important to remain authentic, and this authenticity changes as you grow and evolve as a therapist.

Components of the Multi-Model Play Therapy Model

  • Multi-Modal Play Therapy can work with any trauma. This approach was developed by Leslie Baker and Mary Ruth Cross.

  • The Multi-Modal Play Therapy Model is an integration of three types of modalities:   drawing (expressive arts), sand tray, and drama play.

    • We use this model when a client presents with trauma, such as bullying. Of course, you still need to do all the foundational things, like assessment and building good rapport.

1.  Drawing Exercise

  • Supply clients with crayons (or other drawing materials, such as markers, colored pencils, etc.) and paper, and then ask them to draw the event. If there is more than one event (e.g., if they have been bullied many times), they can choose any event.

  • This choice is based on the trauma model from Centers for Victims of Torture (CVT), in which the client can choose the worst, the first, or any incident for telling the trauma narrative. The drawing can be any representation of the trauma for them. The are no restrictions or directions, other than, “Draw.”

  • During this time, the therapist’s process is to serve as a  witness by using  empathizing skills. As a witness/therapist, you listen to their story and support. Refrain from interpreting during this intervention, as well as during all the stages of multi-modal play therapy.

  • Clients may want to draw more than one picture, and the drawing stage may last more than one session.

  • This is an integrative, non-directive approach, as you are asking them to do something (draw), but you are not asking questions, offering interpretations, or otherwise managing the process, (other than asking, “What is happening in this drawing?”).

  • It may be beneficial to practice empathic listening skills with a colleague to prepare for non-directive therapy.

2.  Sand Tray Play

  • A sand tray has specific sizes, and the standard sand tray has a blue bottom and is filled with sand. You can also have a wet tray and a dry tray, or simply a dry tray with a pitcher of water, so that clients can wet the dry tray. You should also have figures. The tray  should be set up so that clients (and you) can walk around the sand tray, but it is not required.

  • You should direct clients to remember the incident, or one of the incidents, that they drew for you, and ask them to put it into the sand.

    • It doesn’t have to be exact and sometimes the story morphs, and that’s okay. Remember, you are going from a 2-D to a 3-D model, and as they process it, what they drew on the paper becomes somewhat different for them. You’ll find that even if they could have the exact figures, they don’t often choose the exact figures, because they lean into more of a metaphorical land of a sand tray.

    • Refrain from comparing the sand play to the drawing, or searching for a “true” representation of the story.  

    • This is usually a silent exercise, but some people wish to speak during this time.

    • The therapist will take the same role as a witness and support clients as they explain (or not) and show the therapist the sand tray. Walk around the sand tray and look at the sand tray from the level of the sand tray. This allows you and the client to have a full view of the tray.

    • Children typically talk less and interact with the tray more, or may invite you into the play of the tray by asking you to move items in the tray. The older people get, the more controlled their play is, typically. It may also depend on the person.

    • The therapist’s role is to reflect empathically. Adjust to whatever the youth is telling you to do, especially in bullying incidents.

    • You will have fears and reactions; remember to “check” your own fears and worries. When a child is acting out a battle or aggressive situation, it doesn’t mean something is wrong with the child. The containment of the sand tray is a safe place to get all of that energy out, so that they are then able to feel better about having some mastery and control, and then they don’t go back to school and act it out in a negative way. This is why play therapy helps clients process trauma. The acting out is essential.

    • Therapy is not a place for us to rescue or control our clients.

    • At the end of the sand tray session(s), you can ask if there is a title that they would like to give to their tray. You can also ask if there is anything that they would like to add to or take away from the tray before asking for a title. These steps optional for clients. You can also ask if there is a moral or lesson that someone could learn from their tray.

    • This may take a whole session, or it may take more than one session. Trust yourself and your client as you both determine what is an appropriate length for sand tray play. This is a process, not a product.

    • Therapy is both art and science. Being  present with your client will help you understand what they need.

3.  Drama Play

  • We started at 2-D with the drawing, went to 3-D with the sand tray, and now we add in a whole-body experience, or an embodiment of the experience. When people go through bullying or trauma, it is a multi-sensory experience, which is why multiple modalities are helpful.

    • Clients  will choose dress up materials, and they may borrow you as part of their play. For this drama stage, provide large stuffed animals or dolls that can take on other roles in the client’s story.

    • For adults, costumes may be expensive, but you may want to use scraps of materials to put in a bin, such as velvet or see-through materials. You can also cut strips out of the materials, so that clients can tie their costume in place.  Clothes pins are also helpful for this. Masks and crowns are also a good options to have for drama play.

    • Puppets could also be available.

    • The objective is to act out the story with the objects; clients may want to dress up the puppets, for instance.

    • Movement should be encouraged.

    • Your job, if you are not in the play, is to witness it. With permission, you may want to video it so that clients can watch it later. (Reminder: If you use technology in your office, you must have signed consent and manage your own media. You are under the same HIPAA rules as you would be with anything you film. If you keep it on a computer, make sure that when you destroy the computer the hard drive is smashed and destroyed as well).

Summary of Multi-Modal Play Therapy

  • There is an unfolding over these interventions, and you may witness stories begin to change from the drawing to the sand tray to the active embodiment drama play. We are not looking for truth, we are looking for expression.

  • Each one of these exercises takes you closer and closer to yourself. Drawing is a good place to start, because it is not a process  “inside” of you. Sand tray is also very powerful and in-depth, but embodying the story with movement adds an additional, different level of depth. The modalities are organized in a way that creates safety for the client.

  • Depending on your setting,  you may only do drawing and sand tray, which is why it is important for the client to choose the story. They will go as deep as they need to go, and some people will not participate in the drama play, or may request that only you and the creatures participate in the drama play, which is okay. Other people may want to be in the play and embody that, and that’s just a different way of doing it and depends on the comfort zone of the client, and where they are in their survivorship.

  • You want to honor always the client and their process. Therapy is always unique to each person.

Working in Less Than Optimal Conditions

  • When Leslie has had a time limit, such as when she’s worked within a school and only had six sessions, for example, she used the first session to meet with the parent, the second session to meet with the child and parent, leaving her with four sessions. She typically does the assessment in the first two. In the third, she’s introduced the drawing, next the sand tray. The fifth session is for drama play, and the last session is the termination.

    • With these restrictions, it’s important to encourage clients to pick an event with which they are comfortable -- an incident that is not too overwhelming for them.

    • It is important for the last session to include processing - such as asking,”How was that for you?”

    • Make sure to leave a session, or time at the end of the session, to “put them back together,” because otherwise you can unintentionally hurt clients.

  • There are ideal toys and other things that you should have, but schools may not have the resources or access to provide you with all of these things. If you work in a school setting, you should try to have a few items from each of the categories on the list of supplies.

  • Rice or stones may be a good substitute for sand.

  • If you travel, you may be able to gather culturally-specific items and other items that would work well for this model.

  • Thrift stores are a good place to find inexpensive therapy items as well.

  • Sand trays are a rectangular box that is usually 28.5x19.5x3 inches or 57x72x7 in centimeters. It is blue on the bottom because it represents a world, which is blue water, and the sand inside is the earth.

  • You may use blue carpet or paper as the water and other items to represent a sand tray, if you do not have access to one, so that a child can tell their story. A blue component is also not essential. Do not get “stuck” on the perfect representation of a sand tray, or on having ideal supplies. Clients do not tend to notice or care about these details.

  • However, the ability to bury is significant in sand tray play; to allow for this, you can use a packet of kleenex or other items clients can lay over the figures.

Final Thoughts from Leslie

  • Seek out training in your area. Wherever you are, look for the Association for Play Therapy as a local association.
  • Makes sure to add play to your day!

RESOURCES

Links

Downloads from Leslie (also included in The Library)



CONTACT LESLIE

Leslie Baker, LMFT

Therapy 2 Thrive