An Insight into Play Therapy
To learn some more about Play Therapy, That Nursery Life had a chat with Amanda Barrass from Kernow Play Therapy. Based in Cornwall, Amanda works extensively with children who have complex needs as a result of experiencing trauma and neglect.
How long have you practiced Play Therapy and what led you there?
I came to Play Therapy from a background of Primary Education and first qualified 5 years ago, after completing a 2 year, full-time MSc Play Therapy. During this course, I had a placement at Barnardo’s, where I worked part-time. I was working with a variety of needs but, generally, there were a lot of children who had experienced trauma; it could be working with children in foster care or to support adoptive families, both helping the child to process the trauma they’d experienced and also helping the families in responding to that, and feeling more empowered.
I worked quite a lot with children and non-abusing parents who’d experienced domestic abuse in the past, as well as providing support around bereavement. I also worked for three years with the local authority’s post-abuse team, and that was predominantly supporting children and non-abusing parents after a disclosure of sexual abuse. And I’ve now gone fully freelance as a Play Therapist.
What is Play Therapy?
Non-directive Play Therapy is a specialised form of counselling designed for children, where the toys act as the child’s words. It works at the child’s pace and developmental level. A qualified Play Therapist is trained to communicate with a child through the metaphor of play. Working with the characters in a child’s stories offers a level of safety so the child doesn’t feel threatened or interrogated.
What age of children do you work with?
Generally primary age; from three or four up to about 11 or 12. But I have supported families with younger children. Similarly, if a child is older but working at a younger level cognitively, then play might still be appropriate.
For what reasons could a child be in need of Play Therapy?
There are a whole range of reasons from low self-esteem, being particularly anxious, friendship difficulties at school or difficulties sleeping. It might also be something more significant that a child’s really struggling to work through. A bereavement or family breakdown can have a really significant impact on a small child. I work quite a lot with trauma, which can be from abuse, a car accident, a medical procedure, etc..
It must be tough on the therapist, working through all that trauma?
It is tough and Play Therapists have to have regular clinical supervision to ensure they’re looking after themselves and providing the best possible service for their clients.
Where do you tend to meet children for sessions? In your office or other locations?
I prefer working from my office because you need to provide predictability and a sense of safety. Clearly, that can be hard in a busy school environment or other settings. What I love about working from home is that the child can make as much noise or mess as they want, and you don’t have to worry about the next person coming into the room or disturbing a lesson next door. However, for some families and children that’s not an option so I’m also very happy to work with schools. Most schools understand the importance of having the same space each week and are respectful about trying to avoid disturbances as much as possible.
How do you prepare for first meeting a child?
I do a lot of reading, trying to get as much information around the child as possible. For some of the children I work with there are quite a lot of reports that have already been written about their experience and the support they’ve had in the past. I have a conversation with the child’s family and teachers to get an understanding of the difficulties they might be having at home and school.
If I’m seeing a child at my home office then I would first make an appointment to meet them in their home. I might ask families to show the child the playroom on the website beforehand and explain what Play Therapy is. In the safety of the home I would help the child get an understanding of what Play Therapy is and make sure I have verbal confirmation that they’re on board. Watching a child play at home also furthers my assessment of their play development. Sometimes a child might invite me to play, and that’s really helpful for them to see parents, or whoever, playing with me, so they get a clear message that I’m a safe person.
If the Play Therapy was going to happen in school then it would be slightly different; I would set up the room with the toys I’d brought in and invite families, carers and/or a trusted adult from the school environment into the room. This is so a child can see what it’ll look like when they come for therapy sessions and see, again, from the trusted people around that I am someone they can also trust.
What type of toys and materials do you use for therapy sessions?
The idea is to have a range of toys; not so many that they are overwhelming but so you’re giving a clear message that children can bring whatever they want to do to the play. If they need to express their anger through aggressive play, that’s ok (within the boundaries of safety). Similarly, I have very young nurture-play toys out and, quite often for boys, you can see the child initially thinking “I’m not sure about playing with that” but it’s actually what they’re drawn to. So it’s just showing that whatever they need to bring to the play is ok; making sure they know “all feelings are welcome here”.
How do you know when a child is no longer in need of Play Therapy sessions?
Usually, it’s because the behaviours that led to me being contacted in the first place have reduced to the point where that level of concern is gone. Because you’re working in parallel with families, carers, teaching staff and other professionals, they start to understand the child better and what might be behind those behaviours. So those individuals feel more equipped in how to respond. The child is in a better place, and the people around them have resources and strategies to support the child.
Usually we see that the child can better recognise, label and begin to talk about their own emotions. Because of this, we usually see children more engaged in their learning and just feeling increased self-esteem and self-worth. Often, when I’m working with a child of abuse or a particularly distressing incident, it might be that we do enough therapy for now but you know, as they get older, they’re going to need to revisit that.
How much do you work with the adults around children to help them support the child? How do you report back what the child is experiencing or struggling with?
The therapy needs to be confidential so the child can bring what they need to the therapy and not worry about what people at home might think, so it’s a really difficult balance between that and helping the adults understand the child better. After the first couple of sessions, however, the child develops trust in the therapist and feels safe in the room, and they go to a deeper level of play. Once they’re engaging in that play we’re trained to identify “themes”. So that might be patterns of thoughts, feelings or particular situations that you see cropping up in different stories, but you’re beginning to get a better understanding of what the child is struggling with or working on.
I’m trained to report back the themes which gives the child the protection that you’re not going to tell everyone what goes on in their session, but also it’s really important that everybody supporting the child understands what’s going on and knows what they can be doing outside the session to support the child.
For some families, the fact that their child needs to see a therapist can be very distressing and I think if you’re working sensitively and regularly feeding back and giving them strategies of things they might want to consider at home, so they feel involved in the Play Therapy, then that soon dissipates.
How has the pandemic affected your job?
I’ve stopped taking on new referrals so I’ve had fewer clients, in order to ensure that everything’s sanitised and ventilated. For me, the biggest frustration has been the needing to wear a face visor which, for a lot of children, isn’t ok. On an individual basis I’ve had to look at each child and each family’s particular needs. For some, the child’s needs might be great but the family might be particularly vulnerable to Covid-19 so, in that case, we decided to put therapy on hold. I’ve continued to work with some children because the need is there. A lot of the time, when I’m not able to support the child directly I’m supporting families or carers through video calls, but they tend to be in the evening so there’s a lot more evening work at the moment.
Within school it’s been increasingly difficult. It’s got to a point where each child has their own entire play kit that only comes out for that child. In the play room I have individual sand trays and boxes of resources like puppets, blankets, etc..
I’m also aware that I’m getting a lot of referrals coming in because the need is escalating, but the Covid-19 regulations are such that I can’t take anyone else on at the moment, which is very frustrating.
So have you seen an increase in children needing help because of the pandemic?
Certainly. In the last couple of weeks I’ve had a lot of enquiries so I think people are increasingly aware that children’s mental health has been really impacted.
Could you give some examples of the work you’ve done with children?
This child had experienced a lot of domestic violence but was now in a place of safety with their mother. But the child didn’t feel safe anywhere, wasn’t able to engage in learning at school and didn’t feel safe away from mum, as they were worried about their mum. So this image has the aggressive soldiers lined up, but they were beginning to create worlds where there was protection.
The child used the therapy to develop a sense of safety in the play space and, in time, in school.
This child had experienced a lot of violence and neglect and ended up being taken into care. Once they were in care they were able to start developing trust in adults. This image represents the shift in communicating the level of hurt but also that desire for comfort, reassurance and healing.
Is your job rewarding?
I absolutely love what I do. It’ the hardest job in the world and the best job in the world. It’s hard holding all that trauma and wishing the child had had a different experience in life, but seeing a child making progress and seeing that shift is what makes it rewarding.
What types of behaviours or events would suggest a child may benefit from Play Therapy?
Aggression and challenging behaviour are things I get regular referrals for. As mentioned before, nightmares and sleep issues. I think that, quite often, if a child is going through something that feels like they might benefit from some emotional support, while schools are very well-equipped to provide support, if they are experiencing friendship difficulties or are very socially isolated and the level of support from school isn’t helping, it can be really helpful to get a Play Therapist to explore that a bit further.
Is there anything else you’d like our readers to know about Play Therapy?
My biggest worry is that “Play Therapist” is not a protected title and it can be really confusing for families and professionals, when they’re trying to find a Play Therapist, because you don’t really know what you need to look for. So, in relation to that, I got together with some other Play Therapists in Cornwall who shared the same concern. We’re passionate about our profession and we don’t want it undermined by people claiming to be Play Therapists who haven’t had the right training, so we’re part of Cornwall Play Therapy Associates. If you belong to a professional body then members of the public have got all the reassurance they need about the therapist having had a DBS check, having professional indemnity insurance, they’re registered with the ICO so you know all the data is stored accurately, and also there’s a strong code of ethics and practice so if your therapist doesn’t adhere to those or if someone has concerns about the service they’re receiving, they’ve got a grievance procedure.
The Cornwall Play Therapy Associates website is for families and professionals to visit. It explains a little bit more about what Play Therapy is, the different levels of intervention there are to support children, and what level of training a therapist should have for that level of support. It also directs them to BAPT, which is the British association of Play Therapists, that I belong to, and PTUK also have a register of qualified therapists so it directs them to where to find therapists that will be appropriate for their child’s needs.