Alexis and the Thumball: A Story About A Girl Who Did Not Want To Be In Therapy

Eleven year old Alexis had been to therapy many times for her disruptive behavior. Her parents and teachers were unhappy with her and it was her experience that they were ALWAYS mad at her. She did not want to be in therapy, and had made it clear to her parents and to me during the initial visit, that she had no intention of talking or cooperating with therapy.

At the beginning of the second session I checked in with Alexis and she assured me that she still did not want to come to counseling. While I was talking to Alexis I held a Thumball in my hand. I asked her how hard she had tried to convince her parents not to bring her back, and what she had said to them. I asked if there was anything I could do to convince her parents not to bring her back. Apparently there was! Just tell them there was nothing wrong with her.

I reminded Alexis that one of her parent’s concerns was that she had difficulty listening the first time. “How have you done this week, listening the first time?” Alexis assured me that she had done very well, and I suggested she wouldn’t be in therapy very long if that was the case.

image_0Alexis appeared to notice that she was engaging with me, and withdrew. She became a little quieter and the look on her face was somewhat angry. So, I changed the subject and asked her if she knew what a Thumball was? After she replied that she did not, I threw it to her, and immediately asked her to throw it back. This happened fairly quickly so Alexis didn’t have time to think about whether or not she was going to cooperate, and she threw it back. I responded to the first panel. I tossed it to her and she responded. After a few minutes I suggested that since we were stuck here for 45 minutes perhaps we could do something else. I suggested we could continue to talk, play in the playroom, do a sand tray, or play a game. She chose to play a game.

Like all good stories, this story should have a lesson or a moral. Something we can learn from it. First, let’s consider what this story tells us about play. According to the United Kingdom’s Children’s Play Information Service:

  • Play includes a range of self-chosen activities, undertaken for their own interest, enjoyment and the satisfaction that results for children;
  • Very young children, even babies, show playful behavior when they explore sound and simple actions and experiment with objects of interest;
  • Play activities are not essential to meet basic physical survival needs. But play does seem to support children’s emotional well-being as well as a wide range of learning within their whole development;
  • Children can play alone, but often they play with other children and with familiar adults. Even very young children engage in simple give-and-take or copying games with their peers, older siblings or with adults;
  • A playful quality in activities is shown by the exercise of choice, enjoyable repetition and invitation to others to join the play.

So, once Alexis and I threw the ball back and forth, we were engaged in play, a game of catch. However, play as it is engaged in by play therapists is not just a behavior or an activity. It is not just something done with toys in the playroom. The therapist’s attitude of playfulness is important in bringing play into the session and engaging the child. I was playful in my approach to discussing Alexis’ lack of desire to be in the session, but still respected what she had to say and her desire to not participate in therapy. I held a ball in my hand, which implies that play may occur.

image_1

If I held a book, or an axe, something different would have been implied.

The game of catch has likely been with us since humans discovered they could pick something up and throw it, and most children know that you throw the ball back after you throw it to them. So play is both an attitude of playfulness, and an activity.

Winnicott argued that playing is a necessary part of working with children. “Psychotherapy takes place in the overlap of two areas of playing, that of the patient and that of the therapist. Psychotherapy has to do with two people playing together. The corollary of this is that where playing is not possible then the work done by the therapist is directed towards bringing the patient from a state of not being able to play into a state of being able to play. (Winnicott, D.W., 1968)

Play is the most developmentally appropriate way for children to build relationships with adults. Through play children develop critical thinking skills, impulse control, process stressful experiences, and learn social skills.

How does play become Play Therapy? I would argue that the moment Alexis catches the ball, our engagement is deepened and is becoming therapeutic, and we are engaging in Play Therapy. How is that play therapy? Alexis is now having fun with an adult who is enjoying her, liking her, and listening to her. And she’s not being required to talk about what a bad kid she is, so now she can relax a little. As an adult who is also a therapist I bring an expectation and desire to promote change, or resolve difficulties, in a particular way. And this is communicated through my attitude and communication style, and supported by my training, understanding of the problem, and intervention techniques.

Unlike her experience in any of her previous sessions, Alexis’ mood is now elevated and improved as she engages in a playful activity. At her next session, her parents quietly whispered to the therapist as he brought Alexis back to her session, “she didn’t complain once about coming back to therapy.”

3 thoughts on “Alexis and the Thumball: A Story About A Girl Who Did Not Want To Be In Therapy

  1. This counselor was describing treatment for an 11-year old child who had “trouble listening the first time.” The counselor said: “I suggested she wouldn’t be in therapy very long if” she would improve her listening skills. I wonder how busy many counselors would be if all adults who didn’t listen the first time would be required to seek therapy to improve their listening skills. There is also vast research (too much to even begin to cover in this limited space) greatly supporting the notion that most children, if not all, brought to therapy because of their so-called disruptive behaviors, have learned these behaviors in their very own home environments and they are simply acting-out the unspoken tensions in their family system or reflecting it for that matter. Let us pause and remember what Anna Freud, a pioneer for observing children in their own environment, a protocol still followed today, who said:”Children’s behaviors always make sense.” Ms. Freud meant that children simply model their parents’ behaviors.

    • The reader raises an very important point. That is, the need to attend to the child’s environment. “Listening the first time” is used here to frame one of the issues that the client was struggling with. Noncompliant children are typically unhappy children, regardless of etiology.The reader incorrectly assumes that the challenges of the home environment were not addressed during the intake process or in subsequent sessions. The purpose of this note is to demonstrate two things: 1) the value of using play to engage a child who didn’t want to be engaged and who had failed to participate in previous therapy sessions; and 2) how a cognitive technique can be used in play therapy. I’m not sure what literature reader is referring to, but there does appear to be substantial evidence that learning to respond to reasonable authority is a useful skill, and cognitive behavioral play therapy is a valid and useful intervention strategy.

      • xxxxxxxxxxxxxxxxxxxxxxxxxxxxx I was not questioning the intervention technique. Children need social skills and respecting authority is one of those skills needed in a civilized society. I was trying to bring attention to the way Alexis was addressed by the counselor when she thought she had done well, but it appears that I was either not successful in conveying my point, or I may have been inappropriate in questioning it.

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