Play therapy, specifically prescriptive play therapy, is a foundational approach used at Dr. Amanda Bell and Associates (DABA). Prescriptive play therapy is an integrative approach, which allows therapists to work with individual children to identify and address their unique needs. This approach views the child as a unique individual. Prescriptive play therapy operates with the understanding that different interventions are more effective for different children, encouraging therapists to tailor the approach they use to meet the needs of the individual child (Kaduson, Cangelosi, & Schaefer, 2020).
One intervention that I frequently bring into my clinical practice as a play therapist and registered social worker (RSW, MSW) at DABA is Eye Movement Desensitization and Reprocessing (EMDR). As a psychotherapy treatment designed to reduce the distress caused by traumatic memories, EMDR is particularly useful in my work with children and youth who have experienced trauma. As a clinical social worker and registered play therapist, Ann Beckley-Forest, describes in her 2019 article, “Exploring the Intersection of EMDR and Play Therapy,” the intersection of play therapy and EMDR provides practitioners with useful tools to support children in a playful, age-appropriate, and evidence-based way. Beckley-Forest details the intersections of these approaches, highlighting how prescriptive play therapy is compatible with the different phases of EMDR. Below, I draw on my clinical experience to reflect on this compatibility across five of the EMDR phases: preparation, assessment, reprocessing, installation, and closure.
Preparation and assessment
Using play during the preparation and assessment phases of EMDR allows therapists to build a therapeutic partnership with the client. Engaging children in a playful manner supports children remaining within their window of tolerance, while often providing a degree of distance from challenging experiences and trauma to reinforce safety. The use of prescriptive play therapy allows for a combination of approaches. For example, this may look like naming the traumatic experiences, providing psychoeducation, incorporating components of therapy, and providing time for child-centered play. During these two phases directive assessment can be used, such as the art activity, “Colour Your Heart,” in which a child is prompted to choose different colours to represent different feelings, colouring the heart to indicate which feelings they are experiencing related to a specific topic; genograms in the sand tray, which provides a prompt to create a world in the sand using miniatures to represent each family member; or modified board games, adding therapeutic questions or feeling prompts to games such as Jenga, Connect Four or Candyland. These activities allow the therapist to gather important information to assess the child’s readiness to engage in EMDR, the adaptive information they possess, and the child’s understanding of their world. For instance, a child may provide information regarding the connection they have with their parent by choosing an adult monkey holding a baby monkey or by describing their parent as an angry tiger. A clinician might also consider using bibliotherapy, which involves reading a book to the child while providing psycho-education, asking questions, and exploring themes. Bibliotherapy can be used to support children in their understanding of EMDR and provide them with information to prepare for reprocessing, for example teaching children about the “three storytellers” – i.e. their thoughts, feelings, and body sensations. In addition, incorporating child-directed play therapy allows the therapist a window into the child’s interests, developmental level, readiness to engage, as well as space for the therapist to attune to the child’s needs. In these ways, using play in combination with EMDR supports the child’s preparedness and a comprehensive, developmentally appropriate assessment.
Desensitisation and installation
As Beckley-Forest explains, “Children do the majority of their learning through play, both action and imaginative exploration, not through verbal reflection or visual imaginary used with most adults in EMDR.” Like she suggests, in my own practice I have witnessed the importance of incorporating therapeutic stories, sand trays or puppets into the desensitization and installation phases of EMDR. During these phases, play-based approaches support children with complex trauma to access and reprocess preverbal trauma. Beckley-Forest reminds us that although a play-based approach to desensitization and installation may be “more spontaneous and driven by the narrative of the play,” it must remain “grounded in all the elements of the standard protocol, with attention paid to the images, emotions, negative beliefs, and body sensations.”
Closure
Incorporating play therapy into the closure phase of EMDR allows children time to further integrate their work through their natural means of learning: play. The use of play also allows children to ground themselves and emotionally regulate, returning to a state of calm in the present moment, an important aspect of the closure phase. For some children, this might look like using miniatures to play in the sand, or for others choosing to play a game of Spot It or Uno. Just like in the other phases of EMDR, enacting a prescriptive play approach during the closure phase necessitates paying close attention to the individual child’s needs and capacity.
Throughout my 11 years of social work, I have witnessed firsthand the therapeutic benefits of play, most recently in combination with EMDR at DABA. Together, prescriptive play therapy and EMDR provide the therapist with creative tools for intervention and, ultimately, support a child’s journey to healing.
References
Beckley-Forest, A. (2019, March). Exploring the Intersection of EMDR and Play Therapy. Go With That EMDRIA Magazin, 24 (1), 7-11.
Kaduson, H., Cangelosi, D. M., & Schaefer, C. E. (2020). Prescriptive play therapy: Tailoring interventions for specific childhood problems. The Guilford Press.