The Missing Piece: How to Include Parents in Play Therapy for Children with Trauma

Using play therapy with traumatized children and teens is complex, and many play therapists find themselves asking: 

"Where do the parents fit in?"

“What do I do if my client is in foster care?  How do I include parents?”

Too often, parents or caregivers are left out of the process or integrated without a clear plan. This can lead to missed healing opportunities or accidentally triggering trauma.

In this free weekly podcast, we’re diving deep into the critical role of parents (caregivers) in the trauma healing process. 

I’ll walk you through a fictitious case study (Carla) to show you exactly how to move from case conceptualization to successful treatment planning, including parent integration.

🎯 In this week’s episode, we discuss:

• The Conceptualization Process: How to identify the "what" and "how" of parent inclusion.
• Neuroscience & Attachment: Understanding the parent's role through a biological and relational lens.
• Practical Strategies: Key things to consider when bringing parents into the playroom.

Stop feeling overwhelmed and start building a clear plan for your clients' success. 

Join my free Facebook Community Play and Expressive Arts Therapy Playground.

Check out my free resources for mental health professionals working with children, adolescents, and families who want to integrate play therapy and expressive arts into their clinical work.

I work with individuals and agencies to develop successful strategies and meet the treatment needs of your child and adolescent clients and their families using play therapy & expressive arts.

Contact me to schedule a free 30-minute video call if you're ready to level up your skills

Transcript

0:02

Welcome to Next Level Play Therapy, a weekly podcast dedicated to supporting the next generation of child and adolescent therapists to provide exceptional play therapy services. We'll explore all things play therapy to elevate your work with children and adolescents using the therapeutic powers of play. I'll discuss practical tips and ideas so you can provide a transformative experience for your young clients and make a real difference in their lives. So get ready to take your play therapy skills to the next level, and make a lasting impact in the lives of children, adolescents, and families. Hey. Welcome t- welcome to this week's episode of Next Level Play Therapy. I'm Cathi Spooner. I'm a licensed clinical social worker and a registered play therapist supervisor, and today we are talking about parents, especially when you're working with traumatized children and teens. One of the things that I hear all the time when I'm doing consultation in Play Therapy Academy, and now, there's not a doubt in my mind, we're gonna be talking about it in Play Therapy Elevation Circle. In fact, we already have. Those are two of my memberships, online memberships, and we also talk about this in the, uh, trainings that I do, and I'll talk a little bit more about a training that I have coming up in case you're interested. Today, we're talking about integrating parents when you're working with traumatized children, and some of the questions that come up a lot are, how do I integrate parents? And what if my client is in foster care? Which is a great question. How do I integrate parents then? And what I find happens a lot is that either their, their play therapists are not really integrating parents at all, or they're kind of integrating them without any clear plan, and then what ends up happening is they probably are gonna get stalled out at some point, or their things might not go well if they're integrating parents and there's not a really clear plan. So I thought it would be helpful to talk about that in this week's live stream episode, podcast episode. We're gonna continue discussing the case that we discussed last week of my this, um, of, uh, play therapist Sarah and her client Carla, both of whom are fake, but they are based on years, coming up on 35 years of being in the child and adolescent mental health space. So these are things that come up a lot, and so I thought it would be helpful to see how... use a, kind of a fake case study to s- to walk through that process to show what it looks like. So we're gonna continue using the case study of Carla. Last week we went through the case conceptualization process, so if you, if you missed that episode, you may wanna go watch that one if you're listening to the podcast or maybe you're watching the live stream replay on YouTube or, or even LinkedIn. If you're on LinkedIn, the easiest place to find all of the replay episodes, 'cause they automatically, even on LinkedIn, they'll automatically turn into a replay. It's probably the easiest place is to find them on my YouTube channel, which is Cathi Spooner, Renewing Hearts. For this week's episode, we are gonna continue the discussion. Last week we did case conceptualization with Carla. This week we're gonna see how that case conceptualization ties in with your treatment planning. So if you're watching live, I would love to know who's here. Post your name in the comments, what population you work with, where you work, uh, questions, comments, feedback. Join the conversation. And if you're watching the replay, I'd love to know that information as well. So excuse me, join in the conversation if you were... Or message me. Feel free to message me. Also, if you're watching on Instagram, post in the comments or feel free to message me. And for those of you listening to the podcast, feel free to reach out to me. Send a message. If you find the information helpful, I would love it if you guys would share this with your friends and colleagues across social media platforms. Leave a like and subscribe if you are watching on YouTube or Instagram or LinkedIn or all the places. So let's go ahead and get started. I'm gonna pull up the... I, this, this comes complete with PowerPoint slides We're gonna get super fancy. Last, last week when I downloaded my slides and converted them into a PDF, the formatting got a little wonky and I, I forgot to check it before I went live. I have fixed my slides for this time. So if you're watching on Instagram, you won't be able to see the slides. If you're interested, you could always pop over to YouTube and watch it on YouTube. So let's get started for today. Today we're talking about... Our topic today is The Missing

Piece: 6:24

How to Include Parents in Play Therapy for Children and Teens with Trauma. That is what we're talking about today. So let's get started. I actually can make this super fancy-schmancy. Actually, if I do that, I can't see the... All right. So we're talking about Carla, my, uh... and her play therapist, Sarah, both of whom are not real people. So Sarah w- has been a, uh... So this is kind of a recap from last week. We're not gonna go into detail. If you wanna go into detail, watch the episode from last week. So Sarah's a play therapist. She's been doing play therapy for about six years now, working with children and teens. She considers herself to be very comfortable with play therapy, and she is, she is a firm believer in the effectiveness of play therapy. So she's been doing it for a while, she's comfortable with it, and she's struggling. So, um, Car- uh, Sarah's been working with Carla for about five sessions. Sarah's been struggling to figure out the best way to help Carla since she doesn't engage much in the play therapy sessions And Carla's been feeling a little s- I mean, uh, Sarah's been feeling a little stuck with Carla and not sure how to help because Carla is not engaging, so she's a little bit worried that maybe she's doing something wrong. Raise your virtual hand if you have ever felt like that and worried about not doing a good job with your client, feeling a little stuck, right? We have all felt that way. So, sh- um, Sarah's not sure how to help Carla feel safe, um, with her because she's noticing Carla's not really engaging with her. So Sarah was using child-centered play therapy, and because she's a little worried she's not doing it right because Carla's not feeling safe, and she's not talking, and she's not engaging, um, Carla... I mean, Sarah starts asking questions and thinking of some directive activities that she can do to help her, help her client engage more, which leads to second-guessing herself and feeling like she's not doing a good job and then kind of, um, worrying that maybe she's not a very good therap- play therapist or maybe she's not the right fit 'cause s- Carla doesn't seem to feel safe with her. So what are the presenting issues for Carla? Carla's a seven-year-old female. She was referred to therapy with Sarah because she's having nightmares almost every night. She's clingy and refuses to go to bed. She withdraws emotionally and socially, and she's hiding food in her room and becoming distressed whenever limits are set around that, like you have to eat the food in the, in the kitchen s- because we don't wanna get bugs. So if we dive a little bit deeper in that, into that, we find out that Carla was also fa- placed in foster care about 12 weeks ago after experiencing neglect. And, um, so there was also some parental substance use and some homelessness. Sarah hasn't spoken to her foster care worker. I'm gonna make this a little bit bigger. There we go. Um, Sarah has not spoken to the foster care worker, and parent, foster parents really don't know much about what happened- And they don't really know what the plan is as far as the reunification process for Carla or her parents. And Carla's supposed to have weekly supervised visitation at the local park with her parents, but they're not very consistent with their attendance. And during the visitation when they do show up, Carla's slow to warm up to her dad, and she attends, she tends to avoid contact with him. And then after visitation, Carla's usually more clingy and difficult to soothe. Okay, so here's why your case conceptualization matters for your treatment planning. I always say you can't figure out what to do until you first figure out what is at the root of the problem and how are you making sense of it. So what, what tends to happen, and I've noticed this over the years especially when doing a lot of consultation and training, is that a lot of play therapists tend to end up focusing on the behavior because that's usually what's most distressing. And foster parents, um, need this behavior to get better because it's... They're usually overwhelmed and looking to you to fix things for them, for the child. So what ends up happening is there tends to be a focus on the behavior, and then we start labeling behavior like clingy, avoidant, resistant. That's my favorite. I actually have banned that word when I... Uh, for myself, I banned it. I say reluctant. Um, and when I owned a group practice years ago, I banned that word. If whenever I do, whenever I do consultation now, I, I, we change it to resisted, I mean, uh, to reluctant. She's als- they want the food hoarding to stop because that usually ends up with lots of meltdowns, or there end up being bugs in the house and that grosses people out. And then there's some sleep disturbance. And so it makes sense why you would wanna focus on the behavior 'cause you want these to get better, so a lot of times we start doing kind of behavioral approaches. What ends up happening though is the behavioral approaches don't really work well when you have a traumatized client. So what we did in the, with our case conceptualization, AKA our working hypothesis, if we're looking at this through a neuroscience and attachment lens, and I like using a neuroscience and atten- attention... I can't speak today. I like using a neuroscience and attachment lens because I, I believe most- If not all the play therapy models, you can integrate that lens in there easily. So if we're looking at this through a neuroscience and attachment lens, then we're looking at Carla, who's adapted to chronic neglect and instability, and her current behaviors really reflect her survival strategies that are rooted in fear of abandonment, expectation that her needs are not going to be met. Also, that lack of an internalized or felt sense of safety and dependence on external regulation or external, um, soothing for her to, to be able to regulate herself. Her play themes that we talked about in the last session were really reflective of separation, disconnection, and a constant scanning the environment for safety. So our working hypothesis becomes Carla's behaviors are ad- an adaptive response to early attachment disruption, chronic environmental threat, and they're maintained by a predictive brain allocating energy resources based on no consistent experiences of safety or getting basic needs met. So we talked a little bit about the brain has a predictive role of where it needs to allocate energy resources in order to survive. That's what tends to activate those, um, that nervous system dysregulation. All righty. So now here's some of the mistakes that I find play therapists make that contri- uh, contribute to things not going so well. So here's a big one. I find this one happens all the time. So if you-- If you're a play therapist and you are working with kids who are in foster care, maybe you're multitasking right now, this would be a good time to pay attention. One of the biggest mistakes that I find is play therapists not having regular communication and collaboration with the foster care worker. So Sarah needs to find out from the foster care worker what is the reunification plan, because that's going to influence who's involved in the treatment pro- process or maybe who you need to be coordinating with. That's gonna influence what you're going to be doing. So if we're thinking about how are you integrating parents- Or caregivers, you need to have conversations with the foster care worker to find out what is the plan. So, um, is there a reunification plan? There usually is here in the United States. Most of the foster care jurisdictions will try for a year, unless there's like a lot of history of children being removed from parent care, then they tend to go a little bit faster. But it'll usually take ... They usually try to give that first year to, for reunification and the, typically, the goal is always reunification with parents. So as a, as a play therapist, are you going to be working with the parents? Are you going to be part of facilitating some healing from that attachment repair, doing some of that attachment repair with the child, with, with Carla and her parents? Are both parents gonna stay together? Maybe they're gonna get a divorce. Maybe, uh, one parent can't, can't really get their addiction under control, and the other one is working hard on getting their addiction under control. Who's gonna be involved in the play therapy process? That's a key question that only the foster care ca- foster care worker can answer, meaning they need to be telling you what the fos- the reunification plan is, and then you're gonna collaborate with that foster care worker. Are you doing the family play therapy, attachment-based family play therapy to facilitate some healing, or somebody else doing that? If so, will they allow you to collaborate with that person? Typically, they will. Here's the other thing. Here in the United States... If you're outside of the United States, I'm not sure. I'd be curious how this works, so if you're not in the US, feel free to message me. I'd love to know how this works. In the US, the foster care agency is the legal guardian, so if you're getting the treatment plan signed off, you probably need to make sure the legal guardian is signing off on it, and then have that I mean, maybe parent, maybe you're working with parents for reunification and doing some play therapy sessions. Foster care workers, they may be okay with you letting them sign. You really need to be finding that out, because the legal guardian is the one who's supposed to be signing that treatment plan. All righty, so the other thing that I find happens a lot Another mistake is not including caregivers in the treatment process. So Carla need... And here's why that's important. So our case conceptualization is Carla is experiencing all these dysregulated symptoms, not able to go to sleep, very clingy, not f- like clinging to foster care, foster c- uh, foster work. My mouth isn't working today. Clinging to foster parents and hoarding food. So if, if Carla is doing that because she's not- she's in survival mode, then what do we need to help her get out of survival mode? And what we know is those attachment relationships are key for healing for children. I would make the case that's true for adults as well. So Carla needs to re-experience caregiver relationship as safe and reliable to meet her needs. That's going to take time. Her brain needs to start processing that caregivers are safe instead of predicting danger where no danger exists. Also, the caregivers are gonna need support to learn how to use some adapt- attachment-based parenting skills? With a traumatized client, behavior s- strategies don't work very well. Really, the attachment-based strategies are gonna be m- much more effective. So if we're doing that, if you're working with caregivers, let's say you're doing some, uh, attachment repair work with Carla and one of her parents or both of her parents. Maybe both of them were able, really took this as an opportunity to get their substance use disorder under control, and now they're really working hard on recovery. Maybe they're not, maybe they are. Maybe it's the foster care worker and you're working with the foster care work- uh, the foster ca- foster parent. Maybe it's the foster parent that's gonna be involved or both foster parents, and you're gonna need to help them learn some attachment-based parenting skills. What part of that is really assessing their own, what Circle of Security would say is shark music. Meaning when I'm getting activated internally, what is going on with that? In order to effectively co-regulate kids, the adults need to be able to regulate themselves well enough to regulate that nervous system of the child and help them to deescalate and start feeling safer and more- more, more internally regulated. Also, they, you really, you're not really gonna get anywhere unless you have a dedicated time consistently to meet with those caregivers. So I usually recommend meeting at least, in the beginning, at least once a month to establish that rapport with those caregivers, whether it's the foster parents or whether it's the parents. And that's the thing, you've gotta find out from the foster care worker who is going to be involved. I've worked with clients who the... It was a complicated system of adults being involved. There were multiple kids in, in multiple foster placements. In one placement they were moving towards adoption, or they were, they were deciding if they were moving toward adoption. The other foster placement, they wanted all the kids. It, it can be very complex. So sometimes for, for very complex reasons, the foster care worker does not want you as the play therapist to have contact with the foster parents. You have to find this out. That's why you have to have that conversation with the foster care worker. Either way, you're finding out which grownups are gonna be involved in the treatment process, and you're gonna be coming up with a plan to work with those caregivers, whatever that caregiver is. And you need to have those dedicated, if in the beginning at least, very, um, consistent, dedicated parent only, caregiver only meetings so you can establish trust and build rapport. Begin teaching them some attachment-based parenting skills that they're implementing. I typically get, I am typically gonna get a family attachment-based family play therapy session going. But y- I don't do that right off the bat because there's a lot of preparation so that it's intentional, so that the caregiver knows what their role is. They know my, w- what my role is. They know what we're doing in the play therapy sessions and why we're doing it. We're building that collaboration. I'm teaching those attachment-based parenting skills. They're practicing them in the family play therapy sessions. So parents need to have an understanding of what's going on, or caregivers. The other thing is when you're working with kids who have experienced trauma, the likelihood- that those grownups have experienced trauma is very high, so you need to assess that as well. I remember years and years and years ago we were, we were doing, um, family play therapy sessions because the kids were in foster care. We were working on reunification and, and I was supervising somebody that was doing the work, and what we realized in the play therapy sessions was that the, the parent would get, um, trauma triggered when the child got distressed, and she immediately kind of dissociated. And we worked with that, that parent for a few weeks to try and kinda help stay present, and it, it, it didn't go very well. So, um, it was a sad, sad case. So you need to be able to look for these things as well, and then you're gonna adjust your planning for what needs to happen. All righty. So here are some tips for, um, your treatment planning when you are working with traumatized kids and teens and you are trying to figure out how to integrate parents. If you have listened to any of my previous live stream or podcast episodes, you probably would have heard me say what I'm about to say probably nine million times, and I'm going to say it again because it is very, very important. And that is if you're thi- for your treatment planning, you are thinking about what play therapy model are you using. If it's an integrative play therapy model, then your integrative play therapy model is going to be based on some, some theory models. So maybe you are integrating some Gestalt play therapy and some IFS, and maybe you're working on a little EMDR in there as well for those individual counseling sessions. So that's an integrative approach. You're gonna be thinking about those models. And how do those models say or, uh, yeah, how do they, how do they say how parents are gonna be involved? Well, with Gestalt play therapy, there's a way to integrate parents using that play therapy model. So you're going to think about what your play therapy model says. If you're using child-centered play therapy, you are not integrating parents into the session. What you are doing is you are having parent only family, family counseling meetings without client present meetings. And that's where you're doing the, the work with the parents on how to facilitate some healing for their child. If you're using Adlerian play therapy, there's a way to integrate the parents, family members into that play therapy process. So if you're-- whatever your p- whatever your play therapy model is, it's gonna influence how you are integrating parents. Here's the other thing. When you are thinking about integrating parents or caregivers, you really need to think about what is their role. So if we're using a neuroscience and attachment lens, we're understanding the role of parents is to do attachment repair, and we're helping that child's brain to, to accurately predict safety and to, to understand to read cues differently, to make sense of things, to experience the ability to rely on their caregiver su- for support so that they don't have to be in, um, hyperactivated states to constantly be scanning for survival. That is a heavy load on their little nervous system to have to constantly be in safety mode. So what is it gonna look like? What is the role of parents? Well, the role of parents is to help the child feel safe, to use parenting strategies that are gonna facilitate that. Also, holding boundaries in a way that the child will be able to tolerate because boundaries might not feel safe depending on the meaning the child has made from certain behaviors from caregivers. That's that predictive brain process. And how often are you gonna meet with the child? Are you gonna meet with the child for individual play therapy for a while? Are you gonna meet with parents or caregivers separately for a while? Are you gonna meet with them together? When are you gonna meet with them together? What is that gonna look like? How are you gonna prepare them for that? All of these things matter, and these are conversations that you need to be having with your, um, client's caregivers. And if you're going to be using those family play therapy sessions to, um, repair those attachment wounds, then how are you-- what play therapy model are you gonna use, and how are you gonna go about doing that? All right. So let's look at treatment planning for Carla. So if we're using a neuroscience and attachment lens and we're thinking about, uh, an integrative model, so in our integrative play therapy model we're using neuroscience, we're using attachment, maybe there's some other things in there, but for the sake of simplicity we'll just focus on neuroscience and attachment for now. So here would be some of the recommendations that I would include in there, and that would be to have some family play therapy sessions with Carla and foster parents focused on restoring a sense of safety for Carla.'Cause right now we know Carla is living with her foster parents, and we can assume these foster parents are overwhelmed by these behaviors and they need some help knowing how to support Carla. So if par- Um, and here's a little part of it also. If you can get Carla to separate from foster parents, you can do some individual play therapy sessions in the beginning while you're doing the work with foster parents to prepare them for these family play therapy sessions. And what is that gonna look like? What model are you using? What's their role? What's your role? How is that gonna help Carla? What are you gonna do in the sessions? How are you gonna do it? So also you're gonna meet with foster parents to teach them attachment-based parenting skills that they can also practice in those family play therapy sessions. You're gonna get clarification from the foster care worker about what is the reunification plan, and will Carla and her birth parents need family play therapy sessions to ret- repair those attachment wounds. So that is it for today. Those are... Let me do a little bit of a recap. When you are working with children whose parents have, uh, who's, who's traumatized, when you're working with a client who's traumatized and you're trying to figure out how to include parents or caregivers in that process, first you want to think about your play therapy model and how your play therapy model is going to explain the behaviors. If we're using a neuroscience and attachment lens, then when we're talking about trauma, we're talking about, um, how there's not, uh, that the, the behaviors are because of not having a sense of safety and security, and not, not believing that they can rely on others or maybe they need... They c- they're not safe without that caregiver, or if it's more of an ad- avoidant, um, response, then maybe I can't rely on anybody at all. Either of those are gonna put an overload on that child's nervous system, so that's why you're gonna be seeing the behaviors. So if we're using that for treatment planning, then we're, we're thinking about to help Carla feel safe and to begin to internally regulate because she's feeling safe and begin to trust that her needs are gonna get met, then you're really gonna need... I, my, I have a really strong opinion that we really need to involve caregivers in that process, and then your play therapy model is gonna influence what is that gonna look like. But the bottom line is you really need some preparation time to help, um, the caregivers understand what is their role, what is your role, and how is this process gonna work. If your client is in foster care, I cannot stress enough how much you need to have s- at least some collaboration with the foster care worker. I know they're usually really, really busy, and just like there are some therapists who are better than other therapists, there are some foster care workers that are better than other foster care workers. That is true in any profession. Also, I think foster care workers are... They do a lot of hard work, man. So if there's a way we can help them, um, then they're gonna be able to help us do our job, and we can work together to make it work. So forming that, um, c- collaborative partnership with the foster care worker is definitely an important part of the process. So that is it for today. If you're interested, I do have a training coming up on June 6. It's called Healing Trauma and Attachment and Neuro- uh, Healing Trauma Through Play Therapy And attachment. Sorry, I'm fixing my screen here. Uh, a neuroscience and attachment approach. So i- it's a full day training. You can either attend virtually or in person at St. George, Utah. There will be a recorded version available. If you prefer the recorded version, that'll be available after the training. Um, in this training I- I'm updating to... Because we've learned a lot about a lot of things. We've gotten a lot of more information about polyvagal theory, some, some critiques of that, and what are the takeaways that we need as play therapists. There's also this idea of the body keeps score has been refuted. Um, trauma is not stored in the body. And so I'm... I, I've updated a lot of the information because in the first part we're, we're gonna go through that neuroscience and attachment lens as part of our case formulation process, so you have a grounding in what to look for and how to make sense of the way that your client is kinda showing up. But that also includes how are you making sense of what's going on in the play therapy sessions? Also, how are you gonna include parents? And then I'm also gonna walk you through an integrative play therapy model, um, through each stage and do... we'll do some activities for each stage. So by the time you leave that you'll have kind of a framework grounded in the most, uh, updated neuroscience and research information that we have. The other thing is, because I'm a firm believer in the power of community, I see that all the time in Play Therapy Elevation Circle and now my new online membership. We've been going for about a year now, Play Therapy Elevation Circle. That one is... Uh, Play Therapy Elevation Circle is for support so you don't have to do it alone as a play therapist. You have... We do monthly consultations in there to get support and ideas and feedback. We have a monthly book club in there. We also have, uh, ongoing mini trainings. Like this month in May we're gonna have a little mini training on Gestalt play therapy, which is kind of my new obsession, um, Gestalt play therapy And, um, because so when you register for Healing Trauma Through Play Therapy and Neuroscience and Attachment Approach, when you register for the training you're gonna get six, uh, 60 days of access for free for new members to Play Therapy Elevation Circle. Because I, I think it's really important we go to the trainings and then, I don't know if you're, you're like me like Excuse me. Like three weeks later, thinking to myself, "What did we talk about in that training? How do I apply that? I really wish I could have a, um... remember what they talked about." So Play Therapy Elevation Circle is the, is your access to ongoing support, at least for 60 days. You can stay longer as, if you want, most people do, um, to have that ongoing support so that you feel like you don't have to do it alone. We also kinda help each other stay up to date on the most recent things going on. So if you're interested in learning more about my training coming up, Healing Trauma Through Play

Therapy: 40:13

A Neuroscience and Attachment Approach, then you are gonna wanna hop over to my, uh, website at rhplaytherapytraining.com. That's rhplaytherapytraining.com, Renewing Hearts Play Therapy Training. Click on the, uh, training page, and then you'll see Healing Trauma Through Play Therapy: A Neuroscience and Attachment Approach. You can register today. Registration is gonna be closing in a couple of weeks, so you'll wanna get, uh, registered before it closes, and that also gives you access to Play Therapy Elevation Circle for, for at least 60 days at no cost for new members. All righty, so that is it for today, and I will see you guys next week. Bye for now. Thank you for joining me on this episode of Next Level Play Therapy. I hope you found the discussion valuable and gained new insights and ideas to support your work helping children, adolescents, and families heal. If you enjoyed this episode, be sure to subscribe to the podcast and leave a review. Your feedback helps to improve and reach more people who can benefit from this information. Remember, play therapy is a powerful tool for healing and growth. Whether you're a new play therapist or experienced, I encourage you to continue your learning journey to unlock the potential of play in your own work and relationships. If you have any questions or topic suggestions for future episodes, I'd love to hear from you. Connect with me on social media and visit my website at Renewing Hearts Play Therapy Training to stay updated on upcoming episodes, trainings, and resources. Thank you once again for listening to Next Level Play Therapy. Until next time, keep playing, learning, and growing.