I love play. When I think about my own children and how many of my child clients show up in therapy, I instantly think play. Play is a child’s natural language. According to Gary Landreth, professor at the University of North Texas and internationally known writer and researcher in the field of play therapy, “toys are children’s words and play is their language.” Play therapy is the most developmentally appropriate form of therapy for children, as it uses toys to help a child express their inner world. Now, some of you may be wondering, how does play therapy begin to heal a child, particularly one that has been through trauma? To explore this question, I find it important to describe the meaning of a trauma. A trauma is something that happens to you, that is outside of your body’s ability to process, control and navigate. Our body’s way of responding to a trauma is below our awareness, meaning our body reacts automatically in response to a distressing event without us thinking or planning our reaction. This includes fight, flight, freeze, and fawn responses. Trauma is subjective, meaning it is different for every person, based on how their body perceives the threat. A trauma can be an event within our awareness, such as a car accident as a young adult, or preverbal such as emotional or physical abuse experienced as an infant.

As you can see, there is so much depth to the experience of a trauma and as a play therapist, we often find that children do not have the words to describe these very complex and distressing experiences. This is where I find play therapy and EMDR, or Eye Movement Desensitization and Reprocessing, intersect. But first, a word on what EMDR is (bare with me, I know there are so many words to define!) EMDR was developed in 1987 by Dr. Francine Shapiro and has since transformed into a heavily researched, evidenced-based method of working with individuals who have experienced trauma. In EMDR therapy, the therapist utilizes bilateral stimulation (BLS), which includes activating both sides of the body to reprocess aspects of the trauma that is “stuck” in the body. This might look like back and forth eye movements, tapping your body in a left to right motion, or utilizing “theratappers,” which provides alternating bilateral stimulation. More on EMDR therapy in a future blog post!

Because EMDR therapy was first developed and used with adult clients, for years there was a gap in training and resources in bridging the gap between play therapy and EMDR. Luckily, there have been some amazing play therapists who have bridged that gap and have brought forth many valuable resources in supporting children through EMDR and play therapy. These providers will be listed below! Now, finally moving on to EMDR and play therapy. In our practice, we find that utilizing a prescriptive play therapy approach allows the flexibility to incorporate elements of EMDR while also practicing play therapy. In a prescriptive play therapy approach, we use a combination of child-centered play time, along with directive interventions from the therapist that incorporate elements of EMDR. This might look like the following:

• Initial sessions with the child: The therapist leans towards child centered play therapy. This would look like giving the child the space to explore the playroom, while being fully present with the child. A therapist might say something like “In here, you can play with all the toys in many different ways.” This would be followed by the therapist tracking the child’s play, reflecting feelings, building esteem, returning responsibility to the child, setting limits, and offering choices. The primary goal of these initial sessions is to build a trusting, safe, and egalitarian relationship with the child. Through play therapy, the child is able to create distance between their trauma defenses and the processing of traumatic experiences.
• As comfort and trust is built, the therapist will begin to integrate the eight phases of EMDR through short directive interventions. Such interventions might look like guiding the child in creating a timeline through an art based intervention, creating a calm/comfortable place through a drawing or sandtray, or creating a family tree using natural elements found outside. In every session, we give time for the child to continue participating in child centered play therapy, where we focus on presence and attunement with the child.
• As the child proceeds with phase 1 (history taking) and phase 2 (preparation/resource building) of EMDR, the therapist gradually introduces bilateral stimulation in sessions. This can look like explaining to a child that our body does so many amazing things in a left to right movement, and finding various tools in the playroom that we can try in a left to right movement (playing a drum, punching the bop bag, marching around the room, swimming around the room, or following a light up wand with our eyes in a left to right movement).
• Once the child has a wide toolbox of resources (phase 2 of EMDR), the therapist will begin to incorporate phases 3-8 of EMDR. We might incorporate bibliotherapy, storytelling, puppets, drawing/artwork, sandtray, or puppets in supporting the child through the initial assessment and reprocessing of a target (the trauma memory). This all typically happens in short moments in the play therapy session, as trauma reprocessing can come with distressing memories. A truly trauma-informed play therapist is always looking for cues on when the child is getting outside their capacity to continue with EMDR reprocessing in a session, and is adept at attending to shifts in the child’s nervous system. Additionally, a trauma informed play therapist will always include parents/caregivers in treatment, whether it is meeting with parents every 4-6 weeks to discuss important themes and resources from sessions, or meeting at the end of sessions to review important aspects of the session that the child is comfortable sharing.

While this is a very short explanation of a process that takes months, maybe even years, it is a snapshot of what those initial sessions in EMDR and play therapy might look like. One resource I often provide to parents is a short powerpoint with an overview of the 8 phases of EMDR in play therapy. This resource can be viewed using the link below.

Download EMDR & Play Therapy Resource

References:

Beckly- Forest, A. (2019, March 1). Exploring the Intersection of EMDR and Play Therapy. EMDR International Association. Retrieved May 20, 2021, from https://www.emdria.org/research/exploring-the-intersection-of-emdr-and-play-therapy/

Why integrate EMDR and play therapy. Playful EMDR. (2021, October 9). https://playfulemdr.com/why-integrate-emdr-and-play-therapy/