Listening activities to promote cognitive flexibility and communication

Reader Emily Clifton sent in this very useful assortment of interventions. Ms. Clifton earned a gift certificate to childtherapytoys.com for her submission. Learn how you can do the same!

Game: Puppets

Ideal for: group or in family sessions

Instructions: In this game you assign one group the role of puppet, and another group serves as the puppet masters. You will have the group act out a situation. The puppets are doing the actions, but each have a puppet master that will be their voices, so the puppets’ actions have to be guided by what the puppet masters are having them say.

 

Game: Sculpting

Ideal for: group or family session, must be done in pairs

Need: Play-Doh, Legos or another building material

Instructions: The therapist gives each member equal amounts/sizes of play-doh or Legos. The therapist has one person make a sculpture that the other person cannot see. Then they have the builder describe to the other person how to recreate their sculpture. At the end they compare to see if their sculptures are the same. Then you have the participants switch roles. The therapist should ask questions such as: What was difficult about being a listener? What was difficult about instructing others?

 

Game: One-Liners

Ideal for: group or family session

Instructions: The therapist chooses three people to create a scene. Two people are given one generic line. Throughout the scene, they can only say this line. The other person may say whatever they want. You give the participants a general character and scene, such as: two customers and an employee at McDonald’s. During the scene, you can say freeze to help characters that are stuck. Afterwards, you can talk to members about how it felt to have their control limited or to be the one in charge of moving the scene forward, etc.

 

Game: Storytelling

Ideal for: individual, group or family sessions

Need: Deck of Apples to Apples cards, In a Pickle Cards, Story Cubes or other cards with nouns on them,

Instructions: Each person during their turn chooses a card at random. They must use the noun on this card to start, continue, or end a story. They must not negate anything the person before them has said. In a larger group, it is also good to include the parameters around the story getting violent or lewd.

 

Game: 5-2-1

Ideal for: group or family in sets of two or three

Instructions: Group people into twos or threes. Ask each of them to think of a story concerning something that has happened to them that is about five minutes long. Then you assign each person in the group a role: listener or teller (and if there’s a third person–observer). The Teller will have five minutes to tell their story. During this time, the listener can’t talk, but has to show they are actively listening to the story. After the five minutes, the listener has two minutes to summarize the story they just heard, and the teller has to show active listening skills. Then, during the last minute, the teller has to summarize the listener’s summary. Afterwards, the facilitator can ask questions such as: How did you know the listener was listening? How was it to listen without being able to talk? How did you show you were a good listener? How was it to tell a story without being interrupted? What was it like to be an observer and what did you notice? Then each person can take turns taking on the different roles in rotation.

 

Communication/Feeling Identification Activity:

Ideal for: clients needing to identify different cues regarding how people are feeling or the environment around them.

Need: Pictures from magazine or photos of people interacting with one another in natural settings: library, trick-or-treating, cooking dinner, etc.

Instructions: Show kid(s) one picture at a time. You can ask them to identify the who, what, why, when and how of the picture, asking them to point out which contact clue led them to know something about the people in the picture. For example: drinking orange juice could signal breakfast time, or the color of leaves on a tree could signal season. You can also ask about what emotion each person is feeling and how you know this from their body language, facial expression, proximity to one another, etc.

Journey Toward Healing

This article comes to us from Megan Boyd and was originally posted on her blog “The Unconventional Counselor”. Be sure to stop by and check out more great posts like this one. (Ms. Boyd earned a gift certificate to childtherapytoys.com for her submission. Learn how you can do the same!)

The entire nation watched in horror as the events of December 14, 2012 unfolded in Newton, Connecticut.  The Sandy Hook Elementary School shooting took the lives of 28 people that day; 20 innocent children, 6 staff members, the perpetrator, and his mother. There is no possible way to wrap your head around what these families and communities have been through.

As helping professionals, our immediate response is to want to figure out some way to help. As a community counselor, I thought about the children I work with, and how I would have reacted or what I would have done if these were my clients in my community. Traumas of this magnitude are so unthinkable that when they do occur we recognize the long journey that this community is going to need to work through in order to find some sense of peace surrounding that devastating day. Moreover, the 1 year anniversary is quickly approaching, which will trigger the emotions and events for each individual experience.

Approximately 20 miles outside of Newton sits the quaint community of Wilton. Filled with historical buildings and beautiful fall foliage, the towns of Wilton & Newton are not estranged. The residents of each share a history of shared trauma from 9/11, and in most social circles there is at least 1 degree of separation from a direct victim of the Sandy Hook massacre.

Within the past 2 days, a team of counselors comprised of faculty and doctoral students from Mercer University’s Counselor Education & Supervision Program had the opportunity to meet with some of these community residents, particularly those in the helping profession, (counselors, case managers, religious leaders, etc.) that were affected by this tragedy.

As a part of this team, I hope we made a tiny impression on their healing. We lead a 3-course workshop surrounding grief, loss, & trauma, sharing information about what they can expect for themselves as well as their clients they are serving. I am grateful for the opportunity be a part of this team. The following themes were addressed with attendees:

*Systemic Loss, (Community/Familial/Relational)

*Tasks of Grief

*Expected behaviors associated with grief/loss for children and adults

*Concerning behaviors associated with grief/loss for children and adults

*The individualized experience of grief/loss

*Trauma responses; including PTSD and symptomology

*How to make a referral

*Attending to scope of practice

*Self-care assessment

As I made my way back to Atlanta, I had some time to reflect on the experience, and I am finding myself feeling hopeful, humbled, and extremely thankful to have been able to be a part of this.

The space for the workshop was provided by Wilton Baptist Church, which was absolutely beautiful. It was upon first entering this building that the gravity of what this population endured began to set in. The people we met were immediately willing to share their story, how they are connected to Newtown, and how they are connected to the helping professionals.  We are especially thankful for the cooperation and collaboration with The Cooperative Baptist Fellowship for coordinating this trip.

After the first day of the workshop, the pastor conducted an inter-faith worship service. He lit a candle for each of the victims. Prior to the candles being lit, I was able to view the alter. Something about seeing this image and what it represented was an overwhelming visual.

Don’t Break the Ice!

“Don’t Break the Ice” is a popular children’s game that has been around since the sixties. The game can be used as an “ice breaker” and included as an activity in the playroom. Children ages 3 and older will enjoy this game. The game includes 32 small “ice blocks” and one large “ice block.” The blocks fit tightly into a frame. Players take turns knocking the blocks out with a mallet, trying to avoid letting the Polar Bear fall through.

Just like checker play, the child’s approach to playing this competitive game can provide useful diagnostic information. Children with low self-esteem may be hesitant to play, or sore losers. Children with low frustration or anxiety may demonstrate increased agitation as more blocks are knocked out and it gets closer to the skater falling. Just as when playing Checkers, playing Don’t Break the Ice can also serve as a vehicle to communicate interest, concern and affection to a client.

“Don’t Break the Ice” can be played in a session, following the rules of the game. Just like ther types of game play, this facilitates engagement and building rapport with a client. Kenney-Noziska (Kenney-Noziska, Sueanne, 2008; Techniques-Techniques-Techniques: Play-Based Activities for Children, Adolescents, & Families. West Coshohocken, PA; Infinity Publishing) adds a strategy that facilitates engagement, helps establish the therapeutic relationship, and assists client and therapist getting acquainted. Colored stickers are attached to the underside of the blocks. Each color corresponds to a question:

• Blue – Talk about something I like
• Red – Talk about something I don’t like
• Green – Say something about myself, family, or friends
• Yellow– Ask another player a question
• Smiley Face – Choice (or therapist may provide a treat or prize)

There is also the object of playing the “Large Block” version of the game. Game may end when this block drops, four stickers may be placed inside, or if you have extra small cubes the large cube can be replaced.

A third way of using “Don’t Break the Ice” involves adding feelings words to each of the stickers. When one or more of the blocks falls, participants can talk about when they’ve had the feeling identified on the sticker in one of the blocks.

Dr. Gary’s Therapeutic Cootie Game

Over 50 million copies of the Cootie game have been sold since it was introduced in 1949. It is a great preschool game. The game consists of a picture board that depicts all the game parts, Cootie body parts (body, head, antenna, proboscis, eyes, 6 legs), and a die.

This modified version of the Cootie game introduces a therapeutic element. The versions described below focus on social skills and depression, but any story can be written to work on any number of issues and challenges.

First, here are the basics of the game. The object of the game is for each of the players to construct their own Cootie. The first player to do so wins the game. In the therapeutic version, it is not necessary to have a winner. The goal is to complete the story.

Game Play: Each part of the body is identified by a number as follows: 1-Body, 2-Head, 3-Antenna, 4-Eye 5-Probobcis, and 6-Legs. There are two ways to begin the game. Each player rolls the Die once and the high score starts the game, or the youngest (visitor) may go first.

Each player tries to get the body of the Cootie by rolling a “one” spot. If he succeeds, he gets a free roll of the Die, to try for the head. The body and the head must be obtained in the order named, before any other parts of the Cootie can be attached. The legs, eyes, antenna, and eyes can be acquired in any order; all are eligible after the body and head are obtained. The player loses the Die when he fails to roll the number for an eligible part that they have not yet acquired. For example, if the player rolls a 4 and already has the eyes, then the die gets passed to the next player. If they roll a 4 and don’t yet have the eyes, they pick them up and roll again.

One body, one head, eyes, two antenna, one proboscis, and six legs are required to make a complete Cootie.

Once the body and head are acquired all the other body parts can be acquired in any order. In the therapeutic version, parts are acquired but must be added to the Cootie in order, so that a story can be told that makes sense. If a part is acquired out of order, for example a leg before Cootie has a proboscis, the part is picked up and set aside until it can be added.

Social Skills Story
When a one is rolled and the body is acquired each player says: “Cootie wants to play.” When a two is rolled and the head is acquired each play says: “Cootie wants to play with
____________ (choose the fellow player, a peer, or a sibling).

Players are now eligible to acquire body parts in any order, but they are added to Cootie in the order listed below.

When the eyes are acquired each player says: “Cootie is going to look at __________when Cootie speaks. Cootie is going to look at _________ when ___________ talks” and the player attaches the eyes to Cootie. If the player has already acquired the antenna, then that can now be added.

When the antenna is acquired and added each player says: “Cootie is going to listen carefully when __________ talks” as they attach the antenna to the head.

When the proboscis is acquired each player says: “Cootie is going to keep his/her tongue, feet, and hands to herself when she plays” as they add the proboscis to Cootie.

• Each leg represents a skill or affirmation, depending on the child’s needs. Here are some examples:

• Leg 1: Cootie says, “Do you want to play with me.”

• Leg 2: Cootie tells himself: “I won’t get mad is someone says no, I’ll find someone else to play with.”

• Leg 3: Cootie says: “You’re the guest. What do you want to play?”

• Leg 4: Cootie tells himself: “Make sure your friend is having fun.”

• Leg 5: Cootie says: “Thanks for playing with me. I had fun!”

• Leg 6: Cooties tells himself: “I did a good job taking turns and sharing today.”

After each Cootie is completed, the story is retold, repeating each statement as the appropriate body part is pointed to.

Here’s an alternative version for a depressed child:
When a one is rolled and the body is acquired each player says: “Cootie doesn’t want to be sad and bored today.”

When a two is rolled and the head is acquired each play says: “Cootie is going to think of three things he can do today.” The therapist can prompt the child, or make suggestions.

When the eyes are acquired each player says: “Cootie looks for Mom (Dad, teacher, sibling) and gives them a hug” and the player attaches the eyes to Cootie. If the player has already acquired the antenna, then that can now be added.

When the antenna is acquired and added each player says: “Cootie tells himself one thing he likes about his life” as they attach the antenna to the head (the therapist can ask the child to identify that one thing, or make a suggestion).

When the proboscis is acquired each player says: “Cootie enjoys tasty food. The tastiest food I had this week is __________” as they add the proboscis to Cootie.

Again each leg represents a skill or affirmation, depending on the child’s needs. Here are some examples:

• Leg 1: Cootie says, “I don’t have to be bored. I can find something to do.”

• Leg 2: Cootie tells himself: “I don’t have to be sad all the time. I can be happy when _____________.”

• Leg 3: Cootie says: “Two things I like about my life are __________ and __________.”

• Leg 4: Cootie tells himself: “The person who can help me when I’m sad is ___________.”

• Leg 5: Cootie says: “I am beautiful. And then Cootie says it again really loud, I AM BEAUTIFUL.”

• Leg 6: Cooties tells himself: “I am good at ________________.”

Again, after each Cootie is completed, the story is retold, repeating each statement as the appropriate body part is pointed to.

Here’s a story for non-compliance, with a focus on “listening the first time.”
When a one is rolled and the body is acquired each player says: “Cootie listens the first time.”

When a two is rolled and the head is acquired each play says: “Cootie is guessing what his Mom and Dad are going to tell him to do today.” The therapist asks the child to guess.

When the eyes are acquired each player says: “Cootie looks at his Mom’s (or Dad’s or Teacher’s) face when she tells him what to do.” If the player has already acquired the antenna than that can be added now.

When the antenna is acquired and added each player says: “Cootie listens very carefully so that he/she can repeat what she heard” as they attach the antenna to the head.

When the proboscis is acquired each player says: “Cootie tells his/her Mom (Dad, Teacher) what they are going to listen to today” as they add the proboscis to Cootie. The therapist can encourage the child to guess what that might be.

As noted above, each leg represents a skill or affirmation, depending on the child’s needs. Here are some examples:

• Leg 1: Cootie says, “I don’t want to brush my teeth but I will.”

• Leg 2: Cootie tells himself: “I wish I didn’t have to go to bed, but I will.”

• Leg 3: Cootie says: “I am going to listen the first time again!”

• Leg 4: Cootie tells himself: “Listening the first time is easy today.”

• Leg 5: Cootie says: “I had a good day. I listened the first time.”

• Leg 6: Cooties tells himself: “I am good at listening the first time.”

Again, after each Cootie is completed, the story is retold, repeating each statement as the appropriate body part is pointed to.

Family Card Game

We are thrilled to post this therapeutic technique submitted to us by close friend of ChildTherapyToys Liana Lowenstein. Ms. Lowenstein is a therapist and author whose books include three volumes of Assessment and Treatment Activities for Children, Adolescents, and Families; Creative Interventions for Troubled Children & Youth; and Creative Interventions for Children of Divorce. (You’ll also find her articles and techniques peppered throughout this blog.)

The great thing about the innovative techniques presented here is that they require no more than a standard deck of playing cards. However, if you’re interested in using other fun therapeutic card games in your practice, be sure to check out the wide variety offered at ChildTherapyToys!

Therapeutic techniques that involve children or the entire family can be challenging, particularly if the therapist relies on the usual modus operandi of therapy—talk. The First Session Family Card Game (from Creative Family Therapy Techniques Edited by Lowenstein, 2010) provides a means by which talk is integrated into an engaging game. A standard 52-card deck is used for this activity. Introduce the activity by stating, “We are going to play a game that will help me get to know your family.” The rules are explained as follows:

Take turns picking the top card from the deck of cards. If you get a card with an even number, pick a card from the question card pile and answer the question. If you get a card with an odd number, pick a card from the question card pile and ask someone in your family to answer the question. If you pick an ace, ask someone in your family for a hug. If you pick a Jack, Queen or King, you get to pick something from the surprise bag. At the end of the game, everyone who played gets to pick something from the surprise bag.

The question cards have been specifically designed to facilitate joining and to help the family identify treatment goals. Examples of questions for the First Session Family Card Game include:

1. True or False: When families seek therapy they often feel nervous, embarrassed, and/or overwhelmed.
2. Fill in the blank: A good therapist is someone who…
3. What would need to happen in the session today to make you feel like it was worthwhile coming?
4. What do you think needs to change in your family?
5. True or False: Everyone in our family plays a part in making it better.
6. How will you feel if your family gets the help you need?

During the game, there is ample opportunity to observe family dynamics, which further assists in treatment planning. Added elements of the game include hugs to encourage nurturing interactions in the family, and a surprise bag filled with small treats to further engage the clients.

The game can be repeated in the last session (thereby called the Last Session Family Card Game, Lowenstein, 2010) with questions focused on reviewing therapeutic gains. Examples of questions for the Last Session Family Card Game include:

1. What is a positive change someone in your family has made during your time in therapy?
2. What is your family able to do better now?
3. Tell about something you have learned about someone in your family during your time in therapy.
4. Tell about a skill you learned in therapy that you can use to deal with problems that arise in the future.
5. What advice would you give to another family who are experiencing a similar problem that brought you to therapy?
6. Families often teach therapists valuable lessons. Ask your therapist to tell something your family has taught him/her.

Additional questions for the two above versions of the game can be found in Creative Family Therapy Techniques (Lowenstein, 2010). The game can be modified for specific target populations. For example, below are some sample questions from the bereavement version (found in Creative Interventions for Bereaved Children, Lowenstein, 2006):

1. Tell three feelings you have had since your loved one died.
2. Describe a grieving ritual or custom your family followed when your loved one died.
3. Share a favorite memory of the person who died.
4. In what ways has your family changed since the person died?
5. What has helped you the most since your loved one died?

The game is used as a “stimulus for expression of otherwise unattainable information” (Schaefer & Reid, 2001). The therapist provides supportive feedback and validates feelings that emerge during the course of the activity.

About the Author:
Liana Lowenstein, MSW, RSW, CPT-S, is a child and family therapist in Toronto, Canada. She is internationally recognized for her innovative work including numerous books on child and family therapy.

Feelings Hangman

Here’s another great intervention idea submitted by reader Emily Clifton, LISW. Ms. Clifton earned a gift certificate to childtherapytoys.com for her submission. Learn how you can do the same!

Purpose: To help better identify what signals different emotions.

Target population: Ages 6 and up. Can be used in individual, family or group sessions.

Rules: Therapist makes hangman words that are emotions. After client has guessed the word, therapist can discuss what the feeling is with client(s). Then the client or clients each express a time when they have felt that emotion or seen someone else experience it.

Feelings Uno

Here’s an easy and useful intervention idea submitted by reader Emily Clifton, LISW. Ms. Clifton earned a gift certificate to childtherapytoys.com for her submission. Learn how you can do the same!

Purpose: To help identify triggers and start conversations in family/individual session.

Target Population: Can be used in individual, family, or group sessions that include children/adolescents.

Materials Needed: One deck of Uno cards.

Rules: Give each color in the Uno deck a feeling (example: yellow-happy, blue-sad, red-angry, green-jealous). Then whenever someone changes the color, they have to state a time when they felt the emotion that corresponds with the new color.

How Are You Feeling? – A Likert Scale for Kids

Many of the children we work with cannot readily identify and express their emotions. Michelle Sandavol, working with children ages 5 to 11 in a low income, high crime rate area has developed a way to check in with her client’s emotional state. She developed a Likert scale, with visual prompts, using a bulletin board in her room. When the children come into her office they can place a decorated stick on the scale indicating what they are feeling. The goal of this strategy is to engage children on multiple different levels: visually, tactilely, cognitively, and emotionally. When students enter her room she directs them to the bulletin board where they can begin to identify their current emotional state. Once they have done this Ms. Sandavol has an idea of where she can take the session and what interventions can be put in place. She also uses this scale when a child reports or discloses a life event or experience.

There are four scales, with ratings one through five. Each rating point includes a drawing and brief description. The four scales are:

Scared/Brave Scale

Relaxed/Anxious Scale

Happy/Sad Scale

Calm/Excited

Clinicians are encouraged to come up with their own descriptors. For example, Ms. Sandavol’s Relaxed/Anxious Scale has the following descriptors: 1 The most worried & upset you’ve ever been, 2 Very worried & upset, 3 A little worried or upset, 4 Very calm & relaxed, 5 The calmest you have every been.

Michelle Sandoval is a Marriage and Family Therapy Intern working in a school-based setting with children ages 5-11 in a low income, high crime rate, gang-rich area of the bay area. Ms. Sandoval received a gift certificate for ChildTherapyToys for submitting this intervention idea. Learn how you can do the same!

Mancala Feelings Stones

This submission comes from Tammi Van Hollander, LCSW, RPT. MA. Tammi received a gift certificate to childtherapytoys.com for her submission. (And so can you!)

Mancala Feeling Stones

Tammi Van Hollander, LCSW, RPT

Recommended Age Range: 5 to Sixteen
Treatment Modality: Individual or family

Goals:
-Increase feelings vocabulary
-Expand therapeutic dialogue about the issues that matter most to the child
-Help child regulate their feelings
-Provide an understanding of empathy
-Link feelings to actions and how others perceive certain behaviors.

Materials:
-Mancala Game

Description:
Have the child sort the colors of stones into piles. The sorting of stones is a calming and organizing ritual of this activity. The child identifies a feeling with each stone color. For example, they may choose red to be angry. The child picks up the red stone and says, “I’m angry when my mother yells at me.” The adult then says, “Can you put the number of stones in the hole for how angry you get when this happens?” The child may put three or four stones in the hole. Sticking with the angry feelings the adult can ask of a time when they were just a little angry and one stone would represent their anger or a time when they were so angry that all the red stones would be used. A child who is really, really excited for their birthday party may fill the hole with yellow stones. A child who was frustrated with their homework but not super frustrated may put three stones in the hole. They decide. The adult then puts in the opposing side how many stones they thought the child felt. For example, a parent may have thought their child was really mad when they became explosive and it was frightening to them, but the child may have seen the incident not quite as serious. The parent can say, “When you kick and hit, it is not safe, so it looks like you are really, really mad.” The worry hole can be used the same way but can also be used in another manner. The child can name each worry they may have for the day. Each stone represents a worry as they place it in the hole. When the day is over, they revisit the stones and they remove each stone one by one for each worry that did not come true that day. What happens is, most worries do not come true and the hole is emptied.

Discussion:
Mancala is said to be one of the oldest games in the world dating back to 1400BC. Most children enjoy this game and find it quite empowering and calming.

The activity can also be used in parent-child sessions, with families, problem solving with siblings, guidance counselors, OTs and other professionals. For example, the child may put one stone in the hole for a situation where the parent thought the child was very angry. The practitioner can then ask the parent how many stones they thought it looked like when they witnessed the event. The different perspectives can then be discussed and each members’ feelings validated.

About the Author:
Tammi Van Hollander, LCSW, RPT, is a licensed clinical social worker and Registered Play Therapist who has worked with children and families since 1990. She has presented numerous workshops throughout the nation on play therapy and sand tray therapy to teachers, parents, students and clinicians. She currently practices at the Center for Psychological Services in Ardmore, Pennsylvania, specializing in young children, trauma, anxiety, ADHD and sensory processing disorder.

Make Your Own Feeling Chart (and associated play activities)

This idea comes from Stephanie Winn, MFT trainee, Elementary School Counselor.
Stephanie received a $25 Gift certificate to
www.childtherapytoys.com for her
submission.

Making a feelings chart in therapy can be a valuable therapeutic activity. I found that a
combination of National Geographic and Family Fun magazines supplied me well for this
project. I created the chart in the photo with a 10 years old, and sought her feedback as to what
various people looked like they were feeling. This was helpful as it provided a second opinion,
and specifically one from a child. It was with her help, for instance, that I decided to label the
man on the left as “determined” rather than “angry” – a valuable reassessment, and one that
perhaps better supports me in helping kids embrace healthy assertion. After assembling this
chart, I laminated it. Certainly, charts could also be sent home with the child.

This particular chart is hung in my office. I have found that this chart, with its diverse array of
genuine human expressions, really draws children in. The big words don’t scare kids off; rather,
kids become curious as to what some words mean, and that gives us a lot to work with. For
example, a six year old boy who has limited ability to verbalize feelings was drawn toward the
downcast boy labeled “forlorn”. With his keen interest in book knowledge, he wanted to know
what words meant and to show off his academic capabilities. I asked the boy what he thought
the “forlorn” boy might be feeling from his face, and he said sad. I responded that, yes, forlorn is
when you feel sad and lonely and like no one cares about you. He said, “That’s how I feel most
of the time.” This was a huge piece of information and an opportunity for our therapy.

I will also share a game that I spontaneously played with that boy. He found a bouncy ball
on the shelf and began playing with it alone. This is a client for whom my main clinical goals
include increasing his somatic and emotional self-awareness and capacity to regulate, as well
as emerging from his autistic reverie into the relational world. In light of these goals, I invited
him to play this ball game with me. Soon we began bouncing the ball back and forth. I had the
idea to name a feeling each time one of us bounced it to the other, but knowing that would be a
far leap for this client, I began with colors and asked us to take turns naming a color with each
bounce. The boy, in turn, wanted for the person who catches the ball to spell the color that the
other person had named, so we adopted that rule. That met his need to play on his own terms and
to shore up his sense of self with his knowledge. It also increased the mirroring element of the
game (I say “red” then he spells “red”), furthering the goals of therapy.

After a few minutes of colors, I transitioned into feelings. With this client I kept it at simply
naming feeling words, and let him continue the spelling practice, as it offered him a sense of
control and efficacy, though with another client or on a different day I would instead add the
component of sharing a time when you felt that feeling. He was quick to want to change the
subject back to something he was more knowledgeable of, animals, so after a few minutes we
switched to animals.

Another practice I built into the bouncy ball game was to try seeing if you can maintain eye
contact during certain parts of the game, e.g. while spelling the word. For this particular child
that was challenging, but in general as an idea it contributed to the therapeutic goals for a child of this disposition: increasing somatic awareness and interpersonal engagement. Adding
in eye contact as a challenge that is part of a game makes it more fun and gives it a degree
of temporariness, of arbitrariness, of falseness even, that makes it more safely distant for the
socially intimidated child, helping him develop self-efficacy and courage with which to bring to
future social interactions.

Note from Dr. Gary: We hope you have fun with these ideas. Thumballs are ideal for some of the activities discussed, and we also have a wide array of posters, including posters of real children and adolescents.