A Handbook of Play Therapy with Aggressive Children

by David A. Crenshaw clinical director of the Children's Home of Poughkeepsie, John B. Mordock

Overview

Written by two authors with a combined experience of more than fifty years in the residential treatment of severely aggressive-and often traumatized-children, this book has proven invaluable to new as well as seasoned child practitioners. The chapters cover the nuts and bolts of play therapy with this extremely challenging clinical population, including the therapeutic alliance, aims of play therapy with aggressive children, setting limits on destructive and obtrusive behaviors, typical play themes of aggressive children, and developing distancing and displacement through playful action and through teaching, modeling, and structuring action play. Other chapters cover such topics as: how to create more mature defenses and calming strategies; the role of interpretation; the use of spontaneous drawings as a bridge to fantasy play; specific drawing techniques to create access to the inner world of children; how to teach and model pro-social skills and the language of feeling; and how to facilitate affect expression and modulation, contained reenactment of trauma, and children's ability to mourn tangible as well as intangible, unacknowledged and invisible losses. Later chapters cover the therapeutic process and techniques to facilitate termination. The authors introduce the Play Therapy Decision Grid, which is intended to guide the therapist into the levels of therapy best suited for the child at any given point based on the child's resources and the anxiety engendered by the therapy.

Product Details

ISBN-13:	9780765700315
Publisher:	Aronson, Jason Inc.
Publication date:	04/14/2005
Pages:	368
Product dimensions:	6.08(w) x 9.28(h) x 1.08(d)

About the Author

David A. Crenshaw, Ph.D. ABPP, is the Founding Director of Rhinebeck Child and Family Center, LLC in Rhinebeck, New York. He is Board Certified in Clinical Psychology and a Registered Play Therapist Supervisor. He is the author of Bereavement (now in its third printing), A Guidebook for Engaging Resistant Children in Therapy: A Projective Drawing and Storytelling Series, Evocative Strategies in Child and Adolescent Psychotherapy and a forthcoming book, Healing Paths to a Child's Soul. John B. Mordock, Ph.D., ABPP, was employed by the Astor Home for Children for 28 years. In his last position, he directed the agency's community mental health programs, helping to develop a full continuum of services for emotionally disturbed children and their families. He is the author of twelve books, including a textbook on exceptional children.

Table of Contents

Figures     xv
Preface     xvii
Play Therapy, the Child's Expectation and Psychodynamics, and the Therapeutic Alliance     1
Play Therapy     2
The Child's Initial Expectations of Therapy     2
The Contribution of Play Therapy     4
Efforts to Facilitate Verbalization in Play Therapy     5
The Psychodynamics of Gorilla-Suit Wearers     6
The Therapeutic Alliance     10
Difficult Alliances: Children in Gorilla Suits     12
Three Efforts That Aid in the Formation of the Alliance     13
Attend to Their Visible and Invisible Wounds     13
Convey Profound Respect     15
Highlight Their Strengths     15
Signs of a Developing Alliance     16
A Case Example     18
Aims of Play Therapy with Fawns in Gorilla Suits     21
Increased Capacity for Sound Judgment Making     22
Clarifying Intention and Motivation     26
Reduction of Excessive and Unrealistic Self-Preoccupation and Increased Understanding of Self     27
Developing New Perspectives     30
Increased Understanding of the World of Feelings     31
Increased Understanding of Choices and Consequences     32
Fortification of Weak Defenses and Easing of Rigid Defenses     33
Stronger Relationships with Caregivers     33
Finding Meaning and Coherence     33
Facilitating a Vision of a More Hopeful Future     34
Countertransference Feeling Can Aid Treatment     34
Setting Limits on Destructive and Controlling Behaviors     36
Limit Therapy to the Therapy Room     36
Limit Destructive Behaviors     37
Silent Limits     41
Humorous Limits     41
Limit Controlling Behaviors     42
Limit Physical Involvement     45
What Limits Achieve     48
Setting Limits on Other Obtrusive Behavior     49
Limit Efforts to Anger     49
Limit Seductiveness     50
Limit Projections     51
Limit Unproductive Play     51
Limit Dilution of the Therapy Relationship     52
Limit Undisciplined Behavior outside Therapy     53
Limit Comparisons with Other Therapists     55
Limiting Perseveration     56
Limiting Institutional Practices That Distract from the Total Treatment Program     57
Limits Are Not Forever     58
Limits Set in Later Phases of Therapy      59
Limit Defiance, Both Obvious and Disguised     59
Limit Adoption Fantasies     60
A Decision Grid for Play Therapy     62
The Invitational Approach     65
The Coping Approach     70
Differential Decision Making     75
Switching Approaches in Midstream     75
Therapeutic Expectations     77
Orientation to a Positive Future     78
Typical Play Themes of Fawns in Gorilla Suits     79
Control, Dominance, and Power     79
Threat     81
Abandonment and Rejection     82
Separation and Loss     84
Guilt and Shame The: Need for Punishment     85
Deprivation     86
Need for Nurturance     88
Symbols of Healing: Caring for the Wounded and Fixing Broken Things     89
Developing Distancing and Displacement through Playful Actions     91
Clay     93
Harmless Destruction!     94
Reaming Them Out!     95
Knocking Down the Walls of Anger!     95
The Mad Game     96
The Anger Bucket!     96
Having a Field Day with Magic Markers!     97
The Anger Balloon      97
Drawing Strategies     98
Volcano Pictures     99
Storm Pictures     103
Fire-Breathing Dragons     103
Anger Thermometer     105
Encouraging Communication of Violent Fantasies     107
Conclusion     109
Developing Displacement and Distancing by Teaching, Modeling, and Structuring Action Play     111
Getting at Preverbal Concepts     115
Structuring Memory     115
Development of Displacement and Distancing     117
Playroom Toys     121
The Fair Trial     123
Rage toward Others and toward Victims     124
Creating More Mature Defenses and Calming Strategies     126
Developing and Supporting Defenses     127
Splitting     128
Binding and Compartmentalization     129
Dissociation     131
Grandiosity     131
Negativism     131
Development of the More Mature Defenses     132
Encouraging Sublimation and Reaction Formation     134
Calming Activities     135
Rewarding Mature Defenses     138
When to Begin to Interpret Defenses     139
Conclusion     139
The Role of Interpretation: Elementary Concepts     141
Empathetic Interpretations     143
Dynamic Interpretations     144
Preparation     145
Attention Statements     145
Reductive Statements     146
Situational Statements     147
Interpretation of Defenses     148
Step-by-Step Progression     150
Interpretation within the Metaphor     151
Wording the Interpretation     152
Conclusion     155
Making Interpretations: Advanced Concepts     156
Seven Stages     156
Interpretation and Response     157
Working Through     158
Insight     159
Generalization, Externalization, and Projective Identification     160
Transference Interpretations     163
Interpretation of Wishes     166
Conclusion     168
Windows into the Inner World: Spontaneous Drawings as a Bridge to Fantasy Play     169
Windows into the Inner World: Specific Drawing Techniques     176
Boat in the Storm     177
Family Doing Something Together     183
A Safe Place     187
Color Your Life     189
The Magic Key     193
Your Place     196
Draw the Problem     198
Draw the Worst Experience of Your Life     200
Teaching and Modeling Pro-Social Skills with Special Emphasis on Empathy     204
Becoming More "Likable"     205
Appropriate Self-Assertion     205
The Importance of Empathy     207
The Empathy Picture and Story Series     207
Film Clips     211
Empathy Practice Scenarios     211
Empathy for the Healer     215
Teaching the Language of Feelings     217
Basket of Feelings     218
Gingerbread Person/Feelings Map     221
Affect Recognition Pictures and Stories     223
Feelings Charades     229
Facilitating Affect Expression and Modulation     230
Empowerment Play     231
Psychodrama     233
Garbage Bag Technique     233
A Cautionary Note about Timing and Pacing     234
Facilitating Contained Reenactment of Trauma     236
Why Undertake Trauma Work?     237
The Meaning Given to the Experience     238
Secondary Trauma: The Silent Bond     239
Intervening in Posttraumatic Play      240
Crucial Cues from the Child     241
Reflections of Affect and Motives     245
An Illustrative Case     246
Enactment of Trauma as a Result of Unpredictable Triggering     252
Dynamic Flexibility and Titrating the Approach     254
Helping Children to Mourn Tangible Losses     255
Children Grieve in Steps     256
Treatment over Time     257
Acknowledged Losses     258
Dramatic Play and Tangible Losses     261
Structured Activities to Help Express Tangible Losses     262
Memory Book or Album     262
Poems, Songs, and Journal Writing     263
Photographs and "Linking Objects"     263
Reliving Funerals and Memorial Services     264
Family Therapy Sessions     265
Helping Children to Grieve Unacknowledged, Intangible, and Invisible Losses     267
Denial of Loss     267
Conflicted Relationships and Loss     270
Insecure Attachments     272
Divorce and Loss     273
Finding New Meaning and Shaping a Narrative Memory     275
Shaping a New Perspective     275
Structured Activities to Access Feelings Associated with Intangible Losses      275
Structured Drawings     275
Re-Create the World     277
Two Memory Books     277
Evocative Aids: Color-Coded Time Line     278
Evocative Aids: Selected Video Clips     281
Conclusion     282
The Process     283
The First Stage: Anxiety Management     284
Session 1     284
Sessions 2 and 3     285
Session 4     285
Later Sessions     286
Revelations in the First Session     286
Violent Play and Identification with the Aggressor     287
The Second Stage: Conflict Resolution     289
Increased Negativism     290
The Third Stage: Productive Play     293
The Reemergence of Anger and Chaos     296
The Struggle with Confusing Parental Ties     297
The Fourth Phase: Counseling about Present Concerns     297
The Last Phase: Termination     298
Ending Therapy     299
The Process of Ending Therapy     302
Prior Losses Revisited     303
Rehearsals for Ending     304
Specific Techniques for Preparing the Child for Termination     305
The Talk Show Interview      306
The Year Book     306
Jose and Pete on the Mountain     307
Expanding the Circle of Trust     307
The Countdown to Termination     308
Planning Together the Final Sessions     309
One Final Conversation about Words Unspoken     309
Some Concluding Remarks     309
Jose and Pete on the Mountain     310
Bibliography     315
Index     327
About the Authors     337

Editorial Reviews

This comprehensive guide is unique for its thorough coverage and understanding of aggressive and violent children. Play therapists and child therapists are helped through all the stages of treatment along with practical techniques and concrete examples of child-therapist dialogue. It contains a detailed outline for working with a difficult population. The authors cover setting up the therapeutic alliance, understanding defenses, limit setting, as well as play themes and practical techniques, which are all clearly illustrated with visuals and helpful case examples. A 'must-have' addition to any professional or personal library.

Athena A. Drewes

In this companion toUnderstanding and Treating the Aggression of Children, psychologists experienced in providing services to aggressive children and their families present a comprehensive guide to play therapy for professionals to drow on in treating this challenging population.

Scitech Book News

This handbook presents us with a treasure trove, not only of compassionate and sensitive insights into the inner life of abused, highly disturbed children but also of a plethora of specific tools to help violent children. The book belongs on the shelf of any therapist who is deeply committed to helping heal children with severe aggression problems. Many of the ideas will serve as useful strategies for those of us who work with worried or angry children who have less severe traumas but who still need us to help them forge more effective defenses and to learn more self-calming and more reflective techniques in managing their troubles.

PsycCRITIQUES

Aggressive children challenge us as therapists and human beings in ways that reach deep into our culture and our psyche. David Crenshaw and John Mordock offer a rare blend of intelligent empathy and practice-grounded wisdom in meeting these challenges. Every practitioner, from the novice to the expert, can learn from them.

James Garbarino

A treasure chest of ideas for healing the psychic wounds of aggressive, latency-age children. Highly recommended.--Charles E. Schaefer, Ph.D., director emeritus, Association For Play Therapy

Aggressive children challenge us as therapists and human beings in ways that reach deep into our culture and our psyche. David Crenshaw and John Mordock offer a rare blend of intelligent empathy and practice-grounded wisdom in meeting these challenges. Every practitioner, from the novice to the expert, can learn from them.--James Garbarino, Ph.D., Maude C. Clarke Chair in Humanistic Psychology at Loyola University Chicago

Dr. David Crenshaw and Dr. John Mordock have written an extremely informative handbook for child and play therapists where anger and aggression are the major presenting problems. As therapists, we are seeing more and more children where these dynamics exist. This book is filled with practical case examples that directly address therapeutic interactions with these children that the authors have termed 'fawns in gorilla suits.' These authors are obviously two very gifted, sensitive clinicians who offer many years of experience to therapists who are confronted with the aggressive child. This book is a definite 'must' for all clinicians who work with the aggressive child.--Lois Carey, MSW, BCD, RPT-S, New York Association for Play Therapy

From the Publisher

In this age of brief therapies, Crenshaw and Mordock provide a much needed reminder of the long term work that is needed with severely traumatized children....A Handbook of Play Therapy with Agressive Children is exhaustive enough to be appropriate for a beginning therapist, yet has hidden gems that would appeal to more seasoned therapists who can discover them with a sense of "aha."

Bulletin of the Menninger Clinic: A Journal for the Mental Health Professions, Vol. 71, No. 4 (Fall 2007) - Jeanne Bereiter

A treasure chest of ideas for healing the psychic wounds of aggressive, latency-age children. Highly recommended.

Charles E. Schaefer

Every page in this book is a testament to the enormous experience these two authors have in the treatment of aggressive children in residential settings. All aspects of play therapy are covered chapter by chapter and numerous examples are provided about what one might say to a child at the various difficult moments, dividing interpretations as empathic or dynamic. In this client-centred but certainly also therapist-directed therapy, they helpfully discuss how to set boundaries throughout the different phases of therapy and present a helpful array of activities around behaviours and feelings.

Psychotherapy:Theory

Dr. David Crenshaw and Dr. John Mordock have written an extremely informative handbook for child and play therapists where anger and aggression are the major presenting problems. As therapists, we are seeing more and more children where these dynamics exist. This book is filled with practical case examples that directly address therapeutic interactions with these children that the authors have termed 'fawns in gorilla suits.' These authors are obviously two very gifted, sensitive clinicians who offer many years of experience to therapists who are confronted with the aggressive child. This book is a definite 'must' for all clinicians who work with the aggressive child.

Lois Carey

In this age of brief therapies, Crenshaw and Mordock provide a much needed reminder of the long term work that is needed with severely traumatized children....A Handbook of Play Therapy with Agressive Children is exhaustive enough to be appropriate for a beginning therapist, yet has hidden gems that would appeal to more seasoned therapists who can discover them with a sense of "aha."

Bulletin of the Menninger Clinic: A Journal for the Mental Health Professions - Jeanne Bereiter

Every page in this book is a testament to the enormous experience these two authors have in the treatment of aggressive children in residential settings. All aspects of play therapy are covered chapter by chapter and numerous examples are provided about what one might say to a child at the various difficult moments, dividing interpretations as empathic or dynamic. In this client-centred but certainly also therapist-directed therapy, they helpfully discuss how to set boundaries throughout the different phases of therapy and present a helpful array of activities around behaviours and feelings.

Psychotherapy:Theory