Updated: Feb 23
Author: Kristy Schadt, MFT, RPT-S
Billy, age 8, arrived for his first session hesitant but thoughtful. He pulled out R2D2 (Star Wars) from the sandtray shelves and carefully placed it in the sandtray. He then stated "You know that he got totally stuck in the sand and couldn’t move in the last movie”. Billie was diagnosed with Duchene’s Muscular Dystrophy and was dealing with his new manual wheelchair, possibly feeling “stuck in the sand” himself.
Tommy, age 7, was oppositional and frustrated. He had been recently diagnosed with Type 1 Diabetes – having been hospitalized for over a week. When questioned about his hospital experience and feelings he simply moved away and shook his head. I suggested that his mother join us in the playroom and asked if he wanted to bring out the medical equipment. By the end of his session he was gleefully wrapping mom up in gauze, giving shots to one of my Therapy Dogs, “Patches” and laughing at how powerful he felt!
Sarah, age 5, had just begun kindergarten, without any immunizations. The year prior to treatment, she had experienced a bad fall with a traumatic injury and spent 5 days in the hospital. She now would not let anyone near her with a needle! She seemed frozen with fear as mom told her story. As our time together progressed, we practiced shooting objects using oral syringes in the parking lot, played “freeze the bad witch” with magic wands, and we played dress up and tried to make sense of good vs. the bad guys (“Nicky”, my second therapy dog wore both halos and devil horns during play sessions).
In this article I am going to address the importance of recognizing medical procedures as a type of trauma and then will provide a few ideas of how to work with children with medical conditions utilizing play therapy.
Medical procedures have become a fact of life for most of us in today’s world and it is easy to lose sight of the impact on the individual. Common feelings or experiences from medical procedures and events may include a sense of powerlessness, confusion, fear, a sense of abandonment, and a disruption of normal consciousness (from anesthesia or dissociation). When we are not able to process these feelings and experiences, our systems can become overwhelmed leading to symptoms of trauma and even PTSD.
Peter Levine and Maggie Klein, in their book Trauma Through a Child’s Eyes state “Trauma is in the nervous system not in the event. Trauma happens when any experience stuns us like a bolt out of the blue; it overwhelms us, leaving us altered and disconnected from our bodies”. Traumatic medical events impact body and soul. They challenge beliefs about the world being safe and make people feel vulnerable. They disconnect us from our bodies and our family members, who are also dealing with the traumatic effects of both events and treatments.
In play we can deal with trauma in manageable pieces. We can learn to relax and feel more empowered about our experiences. Play provides a medium for processing to occur and connection between family members in play helps heal both parent and child. Children and parents will then feel more connected with their own process and experience relief. They may begin the process of making peace with their disease or injuries and feel a sense of empowerment and pride as this occurs.
Play therapy helps children process what has happened to them in a non- threatening, manageable, and developmentally appropriate way. Through play, children and their families can begin to understand the impact of their experiences and work through issues associated with medical events. Interventions that encourage natural healing to take place can be supported. Healing occurs when we begin to follow our own body knowledge and our psyche’s journey. Encouraging education, family involvement, and some directed interventions when appropriate are all part of the process.
Part of treatment will include following the child as they process their experiences through individual play and family play sessions. Be sure to watch for body and emotional responses and assist the client in finding their own way to heal. Play often reflects procedures that the client has experienced and even prepares the child for medical procedures they may have in the future. Having a variety of medical equipment available for use, including “real equipment” like stethoscopes, IV’s, hospital gowns and syringes (oral) is helpful. This equipment can be obtained by simply asking medical staff for donations to help you with your work.
Children can also benefit from learning how to relax and develop stress management skills. They are able to develop their own healing images through art, sandtray, or creative visualization to help them cope with difficult situations or procedures. These images and experiences can help them tolerate often painful experiences or memories that would otherwise overwhelm them.
Grief and loss issues need to be addressed with both children and their parents. Parents may be fearful of what the future holds, of how to support their child and of how this particular condition will proceed. Grief and loss issues may also include the loss of the dream, for example “how will I grow up to be a kid who jumps and runs.” If the medical condition may lead to death, parents may not want to deal with this loss themselves and will then not be able to help their child deal their impending death.
Families need to have support if they are going to help their children. Educate about normal responses provide referrals to support groups. Helping parents learn about how to advocate for child in school or in the hospital is essential. Family sessions can help siblings cope with losses and stresses in the family as well.
Over the years of working with children in play therapy I have been fortunate enough to have some of my clients visit me to keep me up on how they are doing in life. I also have had the opportunity to have some clients come back to therapy for new issues or to revisit old issues when they reach a new developmental age.
Recently, Billy – referenced above, age 17 now, returned to therapy to help him "work through some things that have come up in my life recently”. We have initially spent some time exploring what has helped him so far in his life in dealing with his medical condition. He is now in a power wheelchair, with minimal movement due to the progression of his disease. Our early play sessions (age 7 to 11) were spent with Billy “trying to kill Muscular Dystrophy”. We shot nerf balls at it, ran it over with a remote control car, drowned it etc. At one point, another way of “fighting MD” was agreed upon…. “My attitude toward life and living is a fight in itself”. “My body may be weak but my mind and soul are strong and alive”! Billie has been writing poetry for many years to help him express his inner journey. I have included one of his poems in this article.
The Boy with the Sleeping Monster
A long time ago there was a kid
Not much different from the others
However, deep inside where no one could see
A monster slept inside of he
As he grew older the monster woke
Taking away things that he needed the most
His muscles grew weak and hard to move
He could no longer do the simplest of things
He struggles to cope with his body nearly broke
But as his body grew weak his mind grew strong
His view of the world wide
As well as his resolve to not give up
The monster inside would not win
He would never be afraid and hide
Edwards, M. and Davis, H. (1997) Counselling Children with Chronic Medical Conditions London, England The British Psychological Society
Malchiodi, Cathy A (1999) Medical Art Therapy with Children London and Philadelphia,
Jessica Kingsley Publishers
Levine, P. and Kline, M. (2006) Trauma Through a Child’s Eyes- The Ordinary Miracle of Healing Berkley, California: North Atlantic Books
The National Child Traumatic Stress Network ( 2008) Medical Events and Traumatic Stress in Children and Families, Philadelphia, PA Website
About the author: Kristy Schadt is a licensed Marriage and Family Therapist, a Registered Play Therapist Supervisor and a Somatic Experience Practitioner. She is in private practice in Simi Valley with Harmony- A Family Counseling Center. Kristy is also on staff at the Free Clinic of Simi Valley, heading up the Play Therapy Training Program for Pre-licensed Professionals. Additionally, she offers classes for therapists in the community to learn more about Play Therapy. You can visit her website to find a listing of future trainings at: www.harmonyfamilycounseling.org