Neurobiologically Guided Play Therapy

Neurobiologically Guided
Play Therapy
Presented by:
Richard L. Gaskill, Ed.D. RPT-S
Sumner Mental Health Center
Wellington, KS 67152
rgaskill@sumnermentalhealth.org
.
All rights reserved 2011 Rick Gaskill and The Child Trauma Academy
Our Brain
Was Designed
for Different
Age.
Our civilization is still in a middle stage,

scarcely beast, in that it is no longer guided
by instinct, scarcely human in that it is not
yet wholly guided by reason.
Theodore Dresier
Greek Philosophers
Ancient Greeks separated
reason from passion,

thinking from feeling,
cognition from emotion.
These aspects were viewed
as an inner battle of the

psyche.
LeDoux, 1996
Plato Reasoned
Emotions are like wild
horses that have to be

reined in by the intellect,
which is like charioteer
controlling wild horses.
We continue to separate the two

Today, we study rationality
(cognitive science), independent

of emotions
Cognitive science was described
as the new science of the mind

Behaviorists believed that inner
states of the mind were not

measurable.
Behaviorists were known to
ridicule those who dared speak

emotion and consciousness.
LeDoux, 1996
Neither is The Full Story

Minds without
emotions are not

really minds at all.
They are cold lifeless
creatures devoid of
desires, fears, sorrows
or pleasures.
They are souls on ice
LeDoux, 1996
Critical Fundamental Principle

(The Use Dependent Brain)
The brain develops and
organizes as a reflection of
developmental experience,
organizing in response to
the pattern, intensity, and
nature of sensory and
perceptual experience.
Perry, 2004
All rights reserved 2006-2011 Bruce D. Perry and The ChildTrauma Academy
All rights reserved 2006-2011 Bruce D. Perry and The
Key Social-Emotional Trauma Facts

Psychosocial trauma negatively impacts all areas of brain
development and functioning.
Social-emotional trauma arouses low brain structures,
inhibiting the CNS.
The rational executive brain is largely inadequate to control
emotional arousal or to change fixed low brain patterns.
Traumatic experiences can permanently alter basic brain
function.
The Brain: a bottom up organization

Primitive brain reactions occur immediately, to stored
patterns associated with threat

This is a nonverbal, illogical, unconscious association
Alarm activation occurs before Cortex processing
Brainstem and Diencephalon posses little subjective
perception
Resulting dysfunctional relational interaction is beyond
awareness and understanding of child, youth, or adult.

(Perry,2006; Perry & Marcellus 1997)
An Uncomfortable Reality:
Children are More Vulnerable
The organizing brain is more malleable
Trauma becomes the neural
organizational set point/homeostatic state
Perry (2006); Van der Kolk, Spinazzola, Baustein,Hopper,Hopper,

Korn, & Simpson (2007)
The Therapeutic Conundrum!
If severe enough, the child will be brainstem
driven. They will think and act in very primitive

ways, being less accessible to academic and
therapeutic interventions using words or
therapeutic relationships as motivational agents
of change.
(Perry, 2006)
Negative Impact of Neglect/Trauma

Cook et al, 2005
Attachment
Marital
Work
Children
Legal Status
Cognition
Lower IQ
Faulty thinking
Perceptual errors
Biology
Illness/ Disease
Life span
Affect Regulation
Emotional modulation
Dissociation
Withdrawal
Cutting, picking, burning
Pseudo seizures
Behavioral Control
Impulse control
Anger control
Coordination/Balance
Self-concept
Outcomes for Adults vs Children

Onset of Trauma
% Asymptomatic
Ratings
Adult
75%
Childhood
33%
van der Kolk, et al., 2007
PTSD Affects: hippocampus, prefrontal cortex,

amygdale
DeBellis, Baum, et al., 1999

Declarative Verbal Memory
Learning
Complex Cognitive Functions
Personality Expression
Decision Making
Social Behavior
Social Evaluative Skills
Impulse Control
Sensory, Visual Decision
Making
Respiratory Control
Hallucinations
Smaller Brain Volumes
Brain Connectivity
Evans, 2009; Stevens, 2011
IQ is not fixed at birth

700 Neural connections
per second.
50% IQ abilities by 4 yrs.
30% between 4 and 7 yrs
80% by 8 years
Environment determines
IQ
Trauma may decrease
working memory by 20%
Basic Neuro-Developmental Principles

The Human Brain is Use Dependent (reflects
our experience)
Stress Moves The Locus of Control Down (From
Thinking to Feeling to Reacting)
Neurosystems Activated Change to Reflect the
Pattern of Activation
Parts of the Brain not Activated Dont Change


The Brain Develops in a Hierarchical Order (lower
functions before higher functions)

The Developing Brain Regions are Sensitive to Specific
Experiences during Specific Developmental Periods

What One Part of the Brain Knows Another Part Does
Not Know.
Social Mastery Grows in the Childs Comfort Zone.
Island of Security/Comfort:
Familiar
Safe
Predictable
Routine
Nurturing
The Brain is a Pattern Seeking Device (it seeks what
is familiar)
Traditional Issues Treated with Play Therapy

(Landreth, Homeyer, Glover, and Sweeney, 1996)
Abuse Neglect
Aggression/Acting out
Attachment Difficulties
Autism
Chronic Illness
Physical Handicaps
Dissociation
Schizophrenia
Withdrawn Children
Traumatization
Emotional Disturbance
Enuresis and Encorpresis
Fear/Anxiety
Grief
Handicapped
Reading Difficulties
Self-Concept
Self-Esteem
Speech Problems
Typical Play Therapy Themes

Norton & Norton, 1992; Sweeney, 1994
Power/Control
Anger/Sadness
Empowerment
Fears/Anxiety
Confusion
Trust/Relationships/Aba
Loyalty/Betrayal
Violation/Protection
Adjustment/Change
Guilt/Self-Blame
Loss/Death
ndonment
Boundaries/Intrusion
Identity
Self-Esteem
Self-Worth
Neglect of The Sensate Dimension of Trauma

van der Kolk, 2004
Traditional therapy promotes understanding and insight into what
is happening in the patients life that stirred up powerful emotions

Most therapies pay scant attention to traumatic changes in body
experience
Brain science demonstrates the origin of emotional states is
conditions of our bodies:

bodys chemical profile,
the state of our internal organs,
muscle contractions in our face, throat, trunk, and limbs .
Multi Level Processing

Decision Making; Planning;
Morality/Ethics/Values; Guilt; SelfBlame; Power/Control; Adjustment/
Change; Boundaries/Intrusions; Selfesteem/Self-worth; Identity
Anger/Sadness/Fear;
Trust/Relationships/Abandonment
/Nurturing; Security;
Violation/Protection;
Separation/Death/Loss
Loyalty/Betrayal;
Tradition Play Therapy is effective for these issues, but is not well suited
for non-verbal, low brain associative learning (non-declarative memory)
that is unresponsive to language, insight, logic, and or understanding
Difficult DSM-IV Diagnoses and Symptoms

Diagnoses:
PTSD
Acute Stress Disorder
Depressive Episodes
Dissociative Reactions
Anxiety Disorders
Phobias
Panic Disorders
Reactive Attachment
Disorders
Symptoms:
Fear
Horror
Disorganized Thoughts
Intrusive Memories
Intrusive Dreams
Flashbacks
Psychological Distress
Physical Distress
Numbing
Memory Problems
Symptoms Continued
Feeling Detached
Vegetative Signs
Restricted Affect
Sleep Difficulties
Irritability
Hyper vigilance
Exaggerated Startle
Response
Unreasonable Anxiety
Response to Exposure
Sleep Problems
Appetite Problems
Loss of Energy
Wt Gain/Loss
Fatigue
Deteriorated Cognition
Poor Concentration
Multi Level Processing

Sleep, disturbing dreams;
intrusive memories; appetite,
feeding energy, primary
sensory integration; motor
coordination, balance motor
planning anxiety, detachment,
numbing,
Autonomic Arousal; ANS
disorders; anxiety; startle
response; physiological distress;
fight/ flight response; W t
Loss/Gain; hyper vigilance;
attention; concentration;
irritability breathing; BP; HR.
fatigue,
Traditional Treatments
The dorsolateral prefrontal cortex (insight,
understanding, and planning) has virtually NO

connecting pathways to low brain centers.
van der Kolk, (2004, 2006)
Traditional Treatments
Psychodynamic, Experiential, & CBT Play Therapys
which emphasize understanding, emotional

processing, insight, and problem solving pay
insufficient attention to disturbed autonomic
physical sensations and preprogrammed physical
actions.
These therapies fail if the brainstem and diencephlon
is poorly regulated
(van der Kolk, 2004, 2006; Perry, 2006)
The Conundrum
Unfortunately, there is an absence of evidence-based
information available on effective treatment for

complex trauma in children.
Malchiodi, 2008
So, What Can We Do?
Rather than put all traumatized children into a one-
size-fits-all, easy-to-export, 20 session group

treatment protocol, we should look back.
There is something to be learned from our ancestors.
Treatment Must Access the Brain at the

Level of Trauma
The Child must Feel Safe
Treatment must focus on the Disregulated brain
location
Treatment must create Positive Feelings (Reward)
Interventions must be Compatible with brain level
Treatment must be Hierarchical
Core Elements of Positive Developmental

Experiences:
Relevant (Developmentally Matched)
Repetitive (Patterned)
Relational (Safe)
Rhythm (Resonate with Neural Patterns/Positive
Entrainment)
(Processes are rooted in neurobiological elements)
Perry, 2008
Keys to Interventions
Psycho-Social Ratio/Interventions must match
developmental age
Interventions must activate the brain region disorganized

Interventions must be patterned and repetitive
Interventions should be fun
Interventions must begin at the lowest disorganized brain
level
Possible History of Problems

Attention/ Tracking Problems
Importance of Stimuli
Identification of a Stimuli
Focusing Attention on a
Stimuli
Sensory Integration Issues
Core Arousal Regulation
Problem
Cant Quiet Physiological

Arousal / Poor Regulation
Transitioning Between
Arousal States
Overly Reactivity to stimuli
Tantrums
Does not sleep well
Irritability
Metabolic Issues
Wt/Ht gain/Obesity/Anorexic
Hording, Gorging, Purging
Poor Regulation of Physical
Functions
Cardio/Resp/ANS
Irregularities
High/Low/Erratic Heart Rate
Blood pressure
Swallowing, Gag reflex
Respiratory Difficulties
Asthma, Allergy, Sleep Apnea,
Diabetes, Diarrhea, Constipation,
IBS, Dermatitis, Hives, Rashes
Research Has Shown:
Self-regulation is the ability to control ones own

emotions, behaviors, and thinking processes.
The growth of self-regulation is the cornerstone of
early childhood development that cuts across all
domains of behaviors..
Zigler,Singer,& Bishop-Josef, 2006
Development of Self-Regulation
Requires an Attuned Caregiver:
Requires Developmentally Appropriate
Activities
Sensory/ Movement Regulation

Relational Regulation
Self-Regulation
Attunement Through Mirror

Neurons
Superior Temporal Sulcus
Cozolino, 2006
(STS): a fold in the cortex

Integrates information
regarding form, location, and
motion.
Neurons are activated when
we see others engaging in
functional behavior
Or when we engage in these
actions
Supports emotional
resonance, attunement, and
empathy with others
In An Attuned State
Caregiver meets childs basic
needs
Caregiver has calm, open
emotional state
Through eye contact, mutual gaze,
facial contact
Creates a harmonic meeting of
minds
Neural activity synchronizes in
right cortex
EEGs are actually in sync
Heart rates synchronize
Hormonal system synchronizes
Critical to later self-regulation
Children who dont experience
this have trouble forming healthy
attachments
Stern, 1985
Important Treatment Concepts

AGE
Brain
Area
Developmental
Goal
Dev Social
Ratio
State Regulation
Play Therapy Model

No Play Therapy Model
Fits well here.
Core Arousal
Interventions are nonverbal,
sensory, movement, rhythmic,
primary experiential, and
relational.
Focus Attention
Postural Regulation
0 to 1 Brainstem
Motor Learning
Equilibrium/
Coordination/
Timing
Metabolic/ ANS
Irregularities
Adult to Child
1 to 1
Primary process and primitive

sensory experiences dominate.
Child Centered
Experiential Therapies
Filial Therapy
Developmental Play Therapy
Floor Time
Theraplay
Brain Stem Intervention

Func
Age
Develop
Play
Relates to others
1 to 1
Solitary play
0 to 1
Exploration of World
by Physical Contact/
nonverbal
Sensory/Motor Play:
Pokes, dumps, pulls,
tastes, smells, stokes
Important Dev
Milestones
Treatment Components
1. Clam your self!

2. Adults must be safe
island
3. Create Positive
Eye Contact
Attunement
Mutual Gaze
4. Calm the child
Smiles
5. Routine = Safety
Seeks Physical Contact
6. Predictable Environment
Enjoys Interactive
7. Limit Stimuli: lights,
Games
sound, people, movement
Sensory Play
8. Eye contact
Enjoys Humor/Teasing 9. Extended gaze
Demands Personal
10. Positive, nurturing
Attention
relationship
Performs for Audience
11. Relational sensory,
Seeks Attuned Relation.
movement activity at
heart rate.
Regulation/Attention/
Engagement with
Environment:
Importance of Ritual in Our Life

Rituals communicate
unity in a relationship
The point of rituals is to
create connectedness
Rituals create a sacred
place for unity in a
relationship
Rituals are calming and
sooth lower brain levels
The glue that holds
relationships together
Human Beings are Build Through Play

(Stuart Brown, MD, 2009)
Play is a Complex, Primal
Process
Promotes Survival
Shapes our Brain
Makes us Smarter
Makes us more Adaptable
Fosters Empathy
Develops Social Skills
Develops Creativity/Innovation
Fosters Problem Solving
Fosters Coping/Calming/Selfregulatory Skills
Brainstem
Enhancements
Pacification (childs sensory modality)
Rocking/Glider/ Swing/Holding
Touching / Stoking
Massage/Wt Balls
Grooming
Cuddling/Hugs/Holding/Snuggi
es
Feeding
Motherese
Lullabies / Songs
Nursery Rhymes
Infant Games
Games Fast/Slow and
Small/Large Movement
Sensory Stimulation
Sand / Clay Play

Shaving Cream
Making Cookies
Songs/Stories/Nature Sounds
Smelling for Identification
Texture Bags for Touch
Sensations
Tastes for Fun, Identification
Looking at Pictures/Paintings
Enhancements for Grade School

and Above
Sensory Stimulation
Sand, clay, play dough

Pottery making
Sculpting with clay
Finger foods
Songs, stories, musical
Pictures, Scent identification
Paintings, coloring,
Water play, slides, fights
Healing Touch
Massage (hand, fingers, foot)
Reiki Touch
Pressure Points
Showing concern for injuries/hurts
Grooming
Nail manicure/painting
Hair Brushing/Braiding
Rituals/Routines that say nothing

has changed in our relationship
Uniting;
Connecting
Closing
Songs, chants, activities
Connecting
Nick Names
Names of endearment
Hand Sakes/High Fives
Commitment
Manners as a demonstration
of respect
Celebrations (birthdays,
graduations
Enhancements for Grade School and Above

Attunement/Relaxing/
Calming:
Listening to music
Singing
Listening to natural sounds
(wind, rain, crickets)
White noise
Reading to the child
Dr Seuss
Poetry
Rhyming Relaxation Exercises
Progressive Muscle Relaxation

Breathing Exercises
Autogenic Phrases
Guided Imagery
Swimming
Yoga
Marshal Arts
Drumming
Bathing with bubbles, bath
salts etc
Massage chairs/pads
Possible History of Problems

(Vegetative Regulation, Control/Sequencing of Motor/Balance)
Primary Sensory
Perception/Organization
Arousal/ Rapid HR/ Tense
Muscle Tone
Poor Coordination/
Balance/Rhythm/Clumsy
Dissociative/Pseudoseizures/ Cutting/ Burning
Focusing, Shifting Atten
Maintain Homeostasis
Memory
Remains in solitary play
Sleep/Wake Regulation/
Nightmares/Waking at night
Appetite/Feeding/Eating
Neuroendrocrine Reg
Hypothalamic: / Stess
Hormones/ Growth,
Menses, Loss of hair, Sexual
development

Age
Brain Area
Dev
Goals
Dev Social
Ratio
Play Therapy Model

Gaskill & CTA, 2008
Sensory Percep
Coordination of
Motor/ Balance
Functions
Sleep /Wake
Cycle
1 to 2 Diencephalon
Regulation of
Need/Drive
Func
ANS Functions
and
Homeostasis
Adult to Child No Play Therapy Model

Fits well here.
1 to 1
Interventions Still nonverbal,
sensory, movement,
Later
rhythmic, primary
experiential, and relational.
1 to 1 to 1
Primary process and primitive
sensory experiences
dominate.
Child Centered
Experiential Therapies
Filial Therapy
Developmental Play Therapy
Floor Time
Theraplay
Diencephalon Intervention
Age
Developmental
Play
Relates mostly 1 to 1
Solitary Play, later likes
to be near others
Developmental
Milestones
Purposeful Gestures
to Communicate
1. Adults must be calm
2. Create Attunement
Fantasy/ Pretend
Play
3. Grant Autonomy When Can
Egocentric
1 to 2
Little empathy/sharing
Lots of Gross Motor

Play
4. Let the Child Lead

5. Activity and Exercise
Need for Autonomy
Holographic to
Telegraphic speech
6. Rhythm, Strong Beat
Poor Emotional Reg

Tantrums
Likes constructive
play toys
7. Motor/Movement
8. Arts Crafts Manipulative
Short Atten Span
Language Skills
9. Give Voice Nonverbal Cues
10. Attempt to extend Play
Reading and Narrative Story Telling

Stories are the archetypal
way we understand.
Explains HOW the world
works.
Even judgments of right
and wrong are understood
as part of story about
events that happened.
Helps form Gestalts,
sequence events, and
construct a reasonable
representation of reality.
Diencephalon Enhancements
Sleep Hygiene
Consistent Bed time routine

Go to bed and get up at the same
time
Quiet time 30 minutes before bed
time.
No TV to put to sleep
No scary movies
Eating/Feeding (social event)
Finger foods
Try different textures/flavors
Rice Krispy Hands
Cooking together
Tea party
Gross Motor: (Phys Exercise)

Crawl through boxes, tubes,
mazes/follow a treasure map
Fast/Slow/Small/Large
Hula Hoops
Balls/Bean Bags
Swimming
(Simon Says:
Duck, Duck Goose
Trampoline/Balance Discs
Brain Gym
Bal-A-Vis-X
Hand Clapping games
Jump Rope/Jumping Balls
Play Ground Equipment
Enhancements for Grade School

and Above
Fine Motor
Lego's/Constucts/Dominos
Puzzles
Tidily Winks
Hop Scotch
Building Blocks
Stringing macaroni/popcorn
Crafts/Jewelry Making
Fingernail Paining
Pick Up Sticks/Jacks/Marbles
Bop IT
Jenga
Operation
Perfection
Blowing Bubbles/Cotton/Ping
Pong Balls back and forth
Music/Dance/Movement
Music
Chanting
Rhyming
Poems
Nursery Rhymes
Rhythm Bands
Reading / Telling Stories
(Dr. Seuss)
Drum Circles
Line Dances/YMCA
Yoga
Tae Kwon Do
Tai Chi
Diencephalon
Enhancements
Simple Narrative
Recall experiences
Show and Tell
Read Stories/Poetry
I Love You Rituals
Books/Pictures/Manipulative
Possible History of Difficulty

Social Relationships, Attunement, Affect Regulation and Pleasure
Emotions Poorly
Regulated
Difficulty
Understanding
Emotions (self and
others)
Poor Social/Emotional
Recognition/
Interpretation
Problems with Stress
Neurotransmitters
Emotional
Learning/Memory
Poor Attachments to
others
Lack of Empathy
Poor Social Skills
Trouble Sharing
Trouble Taking Turns
Seldom Seeks Emotional
Closeness from Caregiver

Fear Memory
(Freezing,
Tachycardia,
Respiration, Stress
Hormones)
Poor
Memory/Learning
Poor Spatial
Navigation (poor
internal compass)
May Lack Motivation
Poorly Engaged in
Social, Pretend
Dramatic Play May
Lack Appropriate
Social Content
Ability to Respond to
Positive and Negative
Stimuli

Few words Symbols to share
feelings
Needs support to play with
others
Antidepressants and
Psychotherapy may increase

the size of the Amygdala
Inhibitory influence on motor
systems (Behavioral Control)
Assoc with Mental Disorders
Reward/Pleasure and
Anxiety Disorders
OCD
PTSD
Separation Disorders
Borderline Personality
Social Phobias
Depression
Binge Drinking
Addiction to Drugs
Learning

Age
1 to 4
Brain Area
Developmental
Goals
Develop
Social Ratio
Processing
Social
Information
Adult to
Child
Affect Mood
Regulation
1 to 1 to 3
Limbic
To
Play Therapy Model

Feeling and Affective
modalities. Includes:
language, relationally and
experientially based tech.
Logical, rational, or conceptual
models are contraindicated.
Play/Pleasure
2 to 1 to 5/6
Attunement/
Attachment
Consolidation of
STM to LTM
Spatial
Navigation
Begin with parallel play with

adult to parallel play with child.
Individual/Family TX:
Child Centered, Relationship,
Filial, Adlerian, Directive, Tech,
Theraplay, Experiential, Sand
Tray, Developmental PT, Art,
Psychodrama
Limbic Intervention
Age
Developmental Play
Enjoy Social Play
Simple Interactive
Play with others
Dev Soc Milestones

Holographic, to
Telegraphic to Complete
Sentences by 3
1. Stay Calm
2. Maintain Positive
Relationship
Toilet Trained
Can be played with
rather than managed
3. Reflect Feelings in self

Pretend Play to Dramatic
and others
Play
Generally Cooperative
4. Use Calming Strategies
1 to 4
Enjoys playing with
Responds to Praise
peers
5. Improve verbal literacy
Concerned with what
is right
Shows Purpose to
Play and Motivation
Mastery Play Begins
6. Let the Child Lead Play
Able to Take Turns and

Share
7. Support Mastery Play
Using words for feelings

Emerging Regulation
of Emotion
8. Use Many Positive

Statements (Credit)
9. Use Expressive Media
Nature Discovery/Play
Helps construct a model of how the
world works
Bases for abstract/mathematical
/scientific learning later
Decreases ADHD Behavior
Stimulates Neural Growth Hormone
Teaches Problem Solving
Stimulates All Senses and Calms,
Regulates
Limbic Enhancements
Social Skills Games/ Activities

Sharing Games
Classroom Chores
Classroom family Rituals
Greeting/parting/calming/connecti
ng
Nick names/pet names/symbols of
regard
Look at Facial Expressions in the
Mirror
Study Pictures in Magazines
Social Group Rituals (handshakes,
songs, greetings)
Therapy Dogs (empathy gentle touch)
Nature Discovery
Natural Obj (shells/nests/rocks)
Traditional Play Therapies

Art / Drawing / Painting
Finger painting
Sculpture
Paper Mache
Crafts for Creative Expression
Little Plays / Dramas

Pretend Play/Dramatic Play
Give and follow directions
Play Hid and Seek
Games of cooperation
Creative Dance, Movement
Enhancements For Grade School

and Above
Emotional learning
Build what is described to

you with Legos
Use terms of
up/down/behind/under to
have others draw what you
describe
Create Mazes from boxes,
sheets or in a garden
Make a compass course and
follow it.
Make a treasure map to find
hidden candy or prize
Have a scavenger hunt
Puzzles to solve of wood/metal
Card Tricks/Magic Tricks
Games:
Sorry
Bingo
Ungame
Talking, Thinking, Doing Game
Attitude Adjustment
Life
Battle Ship
Trouble
Complex Narative
Books
Stories
Social Issues
Aesops Fables
Enhancements For Grade School

and Above
Aesops Fables
Read Stories about social
skills
Books, Poetry
Therapeutic Metaphors
Puppet shows
Memory Games
Family, School, Group Rituals
Birthdays
Anniversaries
Therapy Dogs/Horses
Groom and care for
Cats/Puppies/Animals
Dramatic Play
Concentration
Old Maid
Hearts
Memory
Simon Says
Childrens Games
Duck Duck Goose

Simon Says
Red Light Green Light
Musical Chairs
Candy Land/Flower Garden

(Thinking, Creativity, Problem Solving, Self-Image)
Sensory integration
Poor self-awareness/self-
problems
Cant Delay Gratification
Unable to express
thoughts, wants, likes etc
Trouble with Cooperative
Play
Dramatic Play Doesnt
Makes Sense
Logical sequences in
conversation
image
Difficulty with cause
effect thinking
Unable to plan and
problem solve.
Academic skill problems
Poor insight, abstraction
Underdeveloped moral
thinking, ethics, concern
for others

Age
Brain
Area
Developmental
Goals
Develop
Social Ratio
Abstract Cognition,
Thinking, Reasoning,
Planning, Problem
Solving, Insight,
Foresight.
2 to
Teens
Cortex
Complex Learning,
Memory, Sensory
Integration
Orientation in Time
an Space
Language
Development
Social/Emotional
Competency
Play Therapy Model

All Play Therapy Modalities are now
available (processing experiences
verbally, creatively, emotionally &
cognitively .
Adult to
Child
3 to 1 to 5/6
CBT, RET
Directive Techniques
Game Play
Psychodrama
Art, Sand Tray, Music
Adlerian
Child Centered
Experiential
Gestalt
Psychodynamic
Theraplay
Bibliotherapy
Individual, Group, Family
Cortex Intervention
Age
2 to
Teens
Developmental Play
Parallel to cooperative
play
Play with peers, less
dependence on adults
Play moves to mastery
play and latency age
play,
Industrious
Developmental
Social Milestones
Less Egocentric
Intellectual Skills Grow
Rapidly, Their Arguments
are More Reasoned
Join Groups/Clubs
1. Maintain Supportive
Relationship
2. Give Positive Feedback
3. Recognize the Childs Unique
Qualities
More competitive play

(sports/games)
More Aware of Social Norms 4. Engage in Pretend Play

/Rules/Fairness
5. Play Cooperative Games
Take Pride in doing things
themselves
6. Play Competitive Games
Gender Specific Play is

more Obvious
Develop Interest in
Sexuality
May take risks, show

off, seek recognition
7. Use Creative/Expressive
Mediums
8. Help Solve Problems
9. Discuss Values/Beliefs
Remember: Use Dependent Brain
How two brains

interact determines
the strength of the
neural connections
through which we feel
our feelings and form
bonds with each other
Cortex Enhancements
(use as age appropriate)
Bibliotherapy
Stories with a lesson
Logical Problem Solving

Aesops Fables
Riddles
Annie's Stories
Logic problems
20 Questions
Therapeutic Metaphors
Who or What am I
Story telling about moral issues/character
I am Thinking of an Animal
Jokes/humor
Guess Who
Cartoons/humorous art, characters
Whats missing
Conversations about things of interest to the child Problem Solving
Performing/Creative Arts
Puzzles
Musical expression
Paper Mazes
Dance
Bent Nail Puzzles
Toys that can be taken apart and
Art expression
assembled
Writing
Physical games and sports
Field trips to see visual and performing arts, with
Teach Strategy
discussion of the experience
Teach Character
Role play abstract themes
Team Building
Love, justice, jealousy, loyalty, morality
Team Work
Use puppet, animals, toy people to illustrate
Winning/Losing
experiences
Cortex Enhancements
Games
Charades
Clue
Master Mind
Pictionary
Junior Scruples
Guess Who
Connect Four
Pick-up-Sticks
Sorry
Aggravation
Checkers
Chess
Spades
Old Maid
Battle Ship
Mine Sweeper
Uno
Trouble
Dominos
Memory
Go Fish
I Doubt It
Social Skills Training

Boys Town Program
Conscious Discipline
PATHS
Incredible Years Programs
Social Skills Games
Angry Monster Machine
Family Happenings
Control Patrol
Mountaineering
Self-Esteem Game
Social Security
Ungame
Cultural Appreciation
Books
Pictures
Museums
Cultural Centers
Speakers
Thank You
Go forth and do such

good works as you
have been called to
do.

Neurobiologically Guided Play Therapy

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Neurobiologically Guided Play Therapy

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Neurobiologically Guided

Our civilization is still in a middle stage,

reason from passion,

as an inner battle of the

Emotions are like wild

horses that have to be

We continue to separate the two

(cognitive science), independent

as the new science of the mind

states of the mind were not

ridicule those who dared speak

Neither is The Full Story

emotions are not

Critical Fundamental Principle

The brain develops and

All rights reserved 2006-2011 Bruce D. Perry and The

Key Social-Emotional Trauma Facts

development and functioning.

Social-emotional trauma arouses low brain structures,

inhibiting the CNS.

The rational executive brain is largely inadequate to control

emotional arousal or to change fixed low brain patterns.

Traumatic experiences can permanently alter basic brain

The Brain: a bottom up organization

patterns associated with threat

awareness and understanding of child, youth, or adult.

organizational set point/homeostatic state

Perry (2006); Van der Kolk, Spinazzola, Baustein,Hopper,Hopper,

The Therapeutic Conundrum!

If severe enough, the child will be brainstem

driven. They will think and act in very primitive

Negative Impact of Neglect/Trauma

Outcomes for Adults vs Children

van der Kolk, et al., 2007

PTSD Affects: hippocampus, prefrontal cortex,

DeBellis, Baum, et al., 1999

IQ is not fixed at birth

Basic Neuro-Developmental Principles

Stress Moves The Locus of Control Down (From

Thinking to Feeling to Reacting)

Neurosystems Activated Change to Reflect the

Parts of the Brain not Activated Dont Change

Basic Neuro-Developmental Principles

functions before higher functions)

Experiences during Specific Developmental Periods

Basic Neuro-Developmental Principles

The Brain is a Pattern Seeking Device (it seeks what

Traditional Issues Treated with Play Therapy

Typical Play Therapy Themes

Neglect of The Sensate Dimension of Trauma

Traditional therapy promotes understanding and insight into what

is happening in the patients life that stirred up powerful emotions

conditions of our bodies:

Multi Level Processing

Difficult DSM-IV Diagnoses and Symptoms

Multi Level Processing

The dorsolateral prefrontal cortex (insight,

understanding, and planning) has virtually NO

van der Kolk, (2004, 2006)

which emphasize understanding, emotional

Unfortunately, there is an absence of evidence-based

information available on effective treatment for

So, What Can We Do?

Rather than put all traumatized children into a one-