Thursday 10 September, 2020

The presentation aims to outline the process of a child-centered Play Therapy intervention with a young girl named Pollyanna (¹) that had difficulty in sharing emotions, in recollecting experiences of her early childhood, avoided body contact and resisted to sexual arousal. The therapeutic use of creative tools allowed her to reveal symbolically her early life traumatic experiences and emotions up to then repressed. Through the metaphors of play she made sense of her experiences and expressed difficult feelings connected with them. At around the twentieth session she described her therapeutic process as “Passages to Transformation” by drawing a caterpillar just about to transform into a colourfull butterfly.

Play therapy by contrast to psychoanalytic child psychotherapy, structured (‘problem focused’) play therapy or narrative therapy does not attempt to guide or alter the clients’ experiences but allows with the use of different ways of metaphorical communication such as drawing, embodiment, clay, stories, narratives, puppetry, role play to create a safe and trusting space where experiences and emotions can be expressed and contained.

The intentional use of creative activities as a healing process is what makes the Play Therapy intervention therapeutic, and differentiates therapy from the simple participations in play or art, for their own sake (Cattanach, 1999). The therapist respects the clients’ ability to create through means of expression more suitable to their personality, uses interpretation only as clue for further exploration, respects the clients’ space and time, stays with the feeling of the clients and co-construct a relationship with them that is mediated through the medium of play.

Pollyanna was a nice looking girl, in her early twenties, the first child of a middle class family with a brother three years younger than her. Both her parents were highly educated. She was at that time studying to become a dance-music teacher; she had rather few friends and lived for the last couple of years with a partner five years older than her.

Pollyanna was referred for Play Therapy by her Physician. She had had physical symptoms which they were diagnosed as psychogenic caused rather by anxiety and tension than physical causes and therefore it was recommended to get psychological help. She had had both eyes operated after the retina was detached- something unusual for such a young age; just recovered from pestilent mononucleosis, suffered occasionally from persistent headaches and she several times experienced numbness when trying to stand up for her rights.

It is worth mentioning that when taking her history case, Pollyanna could hardly recollect any of her early life experiences. She had then described her infancy as being good enough, her parents as “a piece of gold”, naïve and caring. She had no special events to share apart from staying for long periods of time with her grandparents, the feeling of being afraid of her father for reasons she could not remember and jealous of her brother, whom she said their mother was treating as a favoured child. She had also shared her ‘illogical’, as she characterized, fear existing since early childhood that had to do with the feeling of being swallowed or eaten up by snakes or sharks that could come out of the bath tub or the sea, therefore she would avoid taking a bath or swim in an open sea.

(¹) the name and demographic information has been changed and it was given written consent for the presentation as well as the art work.

At her early twenties Pollyanna gave the impression of a joyful, rather extraverted, fashionably dressed girl. While moving along though her body stayed stiff and withdrawn; her face hardly changed expressions when sharing emotions and she generally avoided physical closeness. There was the impression that her body communicated what could not be spoken or articulated through words at that time (White, 2004).

It was suggested from the beginning of therapy to use any form of metaphorical communication such as: stories, narratives, sand play, drawing, role-play, puppetry rather than conventional talk to tackle her experiences and process her feelings. The respect of the clients’ ability to create means of expression most suitable to their personality, competencies and emotional life is at the heart of non-directive Play Therapy intervention.

Play Therapy sessions took place once a week for an hour, initially for twenty sessions that where then extended for over a year.
The first sessions were centered on taking her history case and building trust and confidence in the therapeutic relationship.
Little information about her infancy was shared at that point. The questions though asked erased many different issues of her early childhood that she was going to explore at her own pace and in her own time as time went by.

At the fifth session Pollyanna came in a state of panic. She was breathing heavily and was mostly uncomfortable on the seat. She could not make any connection between experiences she might had had lately and the stress she was experiencing. It was proposed to draw a symbol to describe her feeling, give it a shape, colour it, and think of its speed and weight. Drawing is a preferred expressive medium Play Therapists choose in order to make visible and manageable very troubling current experiences and memories.

To find a symbol means detaching from the object it represents and this aesthetic distancing is critical for the safety of the abused child.

(Cattanach 1992, p.43)

Though the projection may at first glance appear to have nothing to do with the client herself or her life, it is “out there”, safe. It is often called a “defense mechanism”, a defense against hurt to the inner self, a disclosure of the self; a projection that may express fantasies, anxieties, fears, avoidances, frustrations, patterns, resistances, guilt, wishes, needs, feelings (Oaklander 1988).
She chose brown and black crayons and created what she called a bowl full of rain.

Her drawing, as she then explained, represented the fear of an impending menace. Containing it in a bowl enabled her to deal with it.

By giving concrete representation to her inner reality and having thus taken appropriate distance from it, she was then encouraged to explore further characteristics of the menace: it was a hard menace, heavy as an iron, hanging over people’s head; it kept coming and going without any notice; sometimes it hurt people with no reason and it was unknown where and when upon it would fall; people had to be very cautious and aware of its warning signs in order to avoid it; they had to be cautious, observant, cool blooded, fast moving and needed to create a shield made of strong, hard unable to be dissolved metal, in order to defend themselves; the “menace” did not mean though any harm, it was in its nature to oppress; it was once created by opponent sadistic forces, and it had itself experience violence; it had no age, it was there eternally, it was and it would stay there; in order to get close to people it changed forms, it could take a liquid form, and thus intrude without being noticed.

She then structured her description into a narrative:
“Once upon a time there was a menace. People were frightened and shivered upon its coming. They were scared in case they would meet it accidentally in the street as they walked unconcernedly. They neither knew when nor when it would come. As the menace was unpredictable and awesome they were very much scared of it. They created strong shields in order to defend themselves and that was how they were carrying on living”.
At the following session she connected her art creation with memories of her infancy.

Working with “line/colour/shape” drawing which clearly bypass the mind and its intellectualization and go directly to the source of the feelings, also allows the clients a unique opportunity vividly to capture “feelings” on paper and to visualize their emotions.
(Jennings 1995, p.126)

Pollyanna shared experiences of domestic violence in her family. Her father used to force both children to obey at his commands by smacking them both hard in the presence of their mother, who remained a mere observer. He often chased his son with a kitchen knife threatening to cut his ear off. It was during one of those terrifying incidences that Pollyanna hid herself under the kitchen table and tried to scream for help but no sound came out; her body had gone stiff, her limbs were unable to move and cold air was surrounding her skin. Several times she was threatened to have her skin burnt by her father’s cigarette ash. In order her torture to end she would plead him to get it over and done with. She neither knew when her father would get upset nor the reason that would trigger his anger. Pollyanna remembered being bitten by hand, by the use of an olive branch or by a “fly killer”. She remembered being hit up around her teens.

Another important aspect of the father’s behaviour that made things even more complex for Pollyanna was that her father often stared at her with lust, made sexual remarks about her appearance and was insisting on being hugged and kissed by her, against her own will. Pollyanna shared feelings of guilt for accepting, not resisting and giving in to his demands. She had not considered up to then that a child can not be in control or exercise free choice with an adult.

Adults have more power than children. This is an immutable biological fact. Children are essentially a captive population; totally dependent upon their parents or other adults for their basic needs…thus they will do whatever they perceive to be necessary to preserve a relationship with their caretakers.
(Herman 1981, p.27)

It was very important at that time for me the therapist not to identify with the victim or with the offender and permit the client to express and understand her own feelings in her own pace. Thus she was able later to identify with a father that had also been a source of caring and affection in her life.

On the tenth session she shared a dream.
The heroin of the dream was a young girl, round about her age that had to save her boyfriend who had been kidnapped, imprisoned and tortured by brute people that used to capture anyone that did not share their personal views.

In order to clarify even more at the theme, conflicts, difficulties coping resources, emotional state, of the client questions were asked.

It was thus specified that the heroin traveled by a big ship at night, in deep darkness, among strangers in order to reach the place the rascals lived. Just before reaching the shore a black and white striped devilfish attacked the ship and nearly capsized it. The heroin got in a cage made of glass. That cage saved her and enabled her to reach the shore. There she confronted the ‘rascals’ who were racists, oppressive, toughie, exercised violence and condemned in prison, whoever was not behaving as expected. The heroin had at first experienced fear, panic and distress, but she then used her brain, intuition, speed, swiftness, ability to use methods to communicate in their language and thus managed to save her friend.

It was proposed to draw the dream in six parts according Mooli Lahad’s BASICPh. The parts followed the questions: who was the main character of the story, what was the task of that character, who or what helped in that task, what were the obstacles in the way, how did the main character go about it, what was the outcome of the story.

The assumption is that by telling a projected story based on the elements of fairy tale and myth, we may be able to see the way that the self projects itself in organized reality in order to meet the world.

(Lahad 2000, p.99)

The connection of that story with Pollyanna’s experiences and her ways of coping with both hers and her parents’ opponent sides (good-bad), her coping methods (glass cage-numbness, powers) were more than obvious in that story.
During the next couple of sessions the first described “piece of gold” naïve and caring parents kept taking different names: “monsters, bloodthirsty beats, disgusting figures that devoured their victims”, as well as “special and precious characters”.

On the fifteenth session it was proposed to Pollyanna to choose some miniatures in order to represent her family members and then to create a short imaginary story using those chosen figures. She chose four miniatures for that task:
• a dwarf with a stupid, jerk, slimy looking face(father),
• a sensitive but powerful fairy (herself),
• a vicious witch who wanted to get rid of the fairy(mother),
• a weasel that bit and occasionally helped the witch(brother).

The narrative she structured follows:
All four characters lived in a forest where warriors were protecting the laws. The dwarf wanted to extinguish the warriors and stay the only one to exercise power in the forest. In order to accomplish his aim he tried to persuade the fairy, using his familiar seductive vision, to hand him over her powerful magic filter. The fairy was deluded and handed the magic filter over to him. Thus the dwarf fought against the warriors and won. Soon after the witch and the weasel, who was the witch’s lawful and loyal servant, helped the dwarf to capture the fairy. They imprisoned her in a cave. The fairy called out for help her friends, the forest’s good spirits, that lent their powers to her and thus she managed to escape. Having regained her strength she was empowered and went to face the dwarf .She ordered him never to enter the forest again.

The story erased different parameters of the client’s inner realities. At that point it was important to notice that though the fairy had had very troublesome experiences, she had managed to escape and to face her offender.

Inspired by that story at the next session Pollyanna brought a song she had written during that week, as well as the music she had composed to accompany it.
The title was: “The Opposite of Zombiefication”; she left the manuscript by me. It follows:

The Joy is over!
No more happy days
The deads are back
From their heavy graves.

Don’t worry, they won’t hunt you
They haven’t come for you
It’s other things they’re after
Though they remember you!

The dead are little children
That you buried alive
You forced them to become
Something they didn’t like.

Don’t worry, they won’t hunt you
They haven’t come for you
It’s other things they’re after
Though they remember you

The deads are back!
The deads are little children
That you buried alive
You forced us to become
Something we didn’t like.

Don’t worry, we won’t hurt you
We haven’t come for you
It’s other things we’re after
Though we remember you.

She explained that she the emotions that emerged from the story she had structured at the previous session inspired her imagination and thus the words and the music to accompany the song came quite natural.

She wanted me to listen to the song. She shared how difficult and painful the process of composing, singing and listening to her own voice had been. She was still feeling the pain there and then; it was a hard to bear feeling that hurt as a burning iron.

She connected her feelings with a documentary film she had once watched on the television. It was about a tribe that lived on a Caribbean island. As far as she remembered the witch doctors of that tribe were giving poisonous herbs to youngsters to render them unconscious. They then buried them alive. The youngsters could feel the process of being buried alive but were unable to react. Few seconds before dying the witch doctors would take them off their graves and give them the antidote that brought them back to life. These youngsters were called ‘zombies’. The experience of not being able to react while being placed in graves alive, stayed vivid for as long as they lived.

Pollyanna went even deeper that day. She recollected a nightmare she often had when she was a child. In that nightmare her parents were hitting her so hard that she would fall in deep sleep. The pain experienced in those dreams was still vivid after waking up. She herself commented that like the zombies her own life experiences of abuse were so strong that she had to freeze many of her feelings in order to bear them.
Inspired by that song at the next session she decided instead of talking to draw.
She created a blur picture using crayons with no borders; black, red and blue curly lines run all over the page; she gave it the title “Hell”.

For complex emotional events and situations, symbols are highly likely to be fragmented and confused (Slade 1994)

She talked about her drawing and said that though it had many different colours, it represented a dark space that contained tension and movement. She discerned four figures three on the left one on the right that could probably represent her parents and her. There was a jelly sort of substance in between them. Amid that jelly substance laid all the episodes she had witnessed during her childhood. She experienced a feeling of suffocation, quite similar to the feeling she was experiencing as a child. She did not want to share more at that point.

During the next few sessions there was no further mentioning of her past.

She was bringing everyday situations mainly difficulties that had occurred in relations with her mother, brother, partner and mates.

On the twentieth session she shared feeling tensed. It was a tension, similar to the one that kept coming and going every now and then since she was a child. She was asked whether that tension was connected with a situation. She described it as a reaction to an intimate body contact that would last more than she could endure. In those cases she had the feeling that her body itself reacted towards a coming danger.

I decided to use embodiment play to get her closer to that feeling, to facilitate her gaining further sensory experience. She initially used words to create a picture; a picture of her hands tightly embracing her body and creating a shield of protection.

In order to get even closer to that feeling I proposed her to let her body take that position and experience there and then the feeling she had just described. She was then encouraged by slowly counting up to three to breathe in through the nose and let out through the mouth that feeling. To facilitate a transformational change I then proposed to her to adopt an opposite posture; a posture in which her body would feel loose. She then experimented with the breathing in and out exercise. Questions about the colour, the weight, the sound the speed of both feelings were then posed that were followed by two drawings.

The first representing the tension was named “The Grip” the other was named “Colours”.

While choosing pencils memories of her mother’s attitude during her adolescence arose. She recollected her mother denying the changes of her body during her adulthood. It was getting clear to her that her mother denied her physical potential to grow; the use of razor to eliminate the growth of hair was forbidden, she was told off when she asked to buy a bra, her mother commenting then that she had nothing to place in it; the word boyfriend was a taboo never to be mentioned. Pollyanna herself connected the tension of her body with the impression just shared: her needs as a child completely diminished as well as ignored by her mother. Her journey through puberty was lonely; she had to find her way through all by herself, searching for answers, craving for crumbles of love from a mother who refused to accept her daughter’s passage from childhood to adulthood, as she said.

On the next session she shared a very vivid sensation of her body being a caterpillar just about to shed its skin and become a butterfly.
The necessary innate seeds of change were beginning to develop.

She talked about the caterpillar and its process of change. It was a colourfull, small but happy caterpillar as it knew that one day it would transform into a beautiful butterfly. Though most people did not like caterpillars, it learnt to ignore that notion as it knew for sure that transformation was to come. It needed though to work hard for it.

It had to look after itself, to search for food, keep warm, create a shelter to hide from danger and be cautious when coming out to the sun. On several occasions birds tried to eat it up as it looked delicious. On others people nearly stepped on it as they did not like it; it got in their way. Both birds and people kept trying to extinguish it. It always managed to escape though… and one day it discovered the way to hide from them. It built its own safe place, where no one could enter and thus slowly- slowly it started to transform. Time did not matter; it could take as much time as it needed; the result was that counted and it would be rewarding. Time went by and one day it looked at the mirror and saw itself! It was transformed! It had become a pretty, big, colourfull butterfly. Joy overfilled its heart!

That narrative represented more or less Pollyanna’s process of transformation she had gone through Play Therapy. She realized that more issues of her past were to be revealed and that the journey had to carry on going in order to resolve past experiences and let go negative influences. Therefore we both decided to carry on after the twentieth session for as long as needed. We both respected the gentle pace we had to follow for new resources to be intergraded into her life.

Conclusions

More detailed approaches used in this process were not discussed in depth in this presentation. The intention was to focus on the means of creative work used by the client to externalize internal experiences and memories of her past hard to bear and difficult to be verbalized. The Play Therapist and the client established a relation together and mediated that relationship through different medium of play.

In the early stages of therapy familiarity, boundaries and trust were established. Having gained a sense of emotional security in a therapeutic relation that contains, sustains, accepts, respects the client’s pace, time and abilities, the patient was enabled not only to explore experiences of the past but also to discover her own mechanisms of coping, dealing, facing, and gaining mastery over those experiences.

As she was becoming more confident, she started giving concrete representation to her inner reality. By the use of mostly projective and embodiment play she was enabled to bring up memories of her childhood, recognized their reality and prepared defenses so that to be more assertive. The scenes of domestic violence, as well as behaviours that were both inappropriate to relationships and to her age were externalized, understood and assimilated. She symbolically externalized issues and feelings she identified with and clarified them without reducing or simplifying them.

The passages to transformation were revealed as the therapy was moving along:

The horrifying memories had to be contained in a bowl and then while they were projected ‘out there’ safe they were able to be explored. By structuring narratives conflicts, difficulties, coping resources were expressed, understood, explored and clarified. It was thus that the “deads came back from their graves and faced their offenders”. The pronoun ‘they’ became ‘we’ (not yet ‘I’). The client then dared to come closer to her own experience of ‘dying alive’ and ‘freeze’ in order to survive the abuse.

Complex emotional tensions that were first symbolized as fragmented and confused were then experienced through embodiment play. The body started getting sensory experiences. Those experiences were witnessed in all their fullness by both herself and the therapist. We were both constructing a relationship gaining access into her internal world and memories of her past. She described the passages to transformation of that Play Therapy process sharing the sensation of being a caterpillar shedding its body in order to become a colourfull butterfly. She had found her inner seeds of change and was at the threshold of experiencing a less distorted sense of self and others, gradually leading her way to find forms of resolution. She had recognized the inner ability to heel by using forms of art. The inner resources lying dormant within her had become alive.

References

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