Using the Sand Tray to Detect Family Roles

Here’s another interesting article submitted by reader Martha Nodar on the subject of sand tray therapy. Ms. Nodar earned a gift certificate to childtherapytoys.com for her submission. Learn how you can do the same!

Bradshaw (1988) argues families are systems with systemic needs which are typically fulfilled, mostly unconsciously, by family members. These family members may become unwitting participants drawn into the family drama. In dysfunctional families triangles are common because they serve the purpose of providing a relief to the drama. In such cases, children and adolescents may unconsciously adopt roles within their family in order to survive their environment and help bring some balance to the scene. For instance, a so-called difficult child may be unconsciously acting-out the unspoken tensions within the parental dyad (Kerr & Bowen, 1988). Fairy tales have a way of representing these family dynamics in a way that is both nonthreatening and entertaining. Sandtray also provides a safe forum to give a voice to the unspoken.

Sandtray and Fairy Tales

Lowenfeld (1993) suggests children see the world around them as “stories” that can be represented in the “tray” (p. 16). Lowenfeld argues fairy tales are an effective way to access two worlds at the same time—a fantasy world and one’s internal world through the use of metaphors. Drawn by her experience, Lowenfeld contends that children may enjoy fairy tales because “the rules of life within it are magical and different altogether from those at home” (p. 16). Fairy tales serve a purpose in cognitive and emotional development by giving children an opportunity to make sense of their world. Below is a sandtray activity that may be used with fairy tales designed to help the play therapist uncover the roles children or adolescents and their families may be playing within their family system.

Detecting Family Roles in the Sand (sand tray activity)

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  • Have the sandplayers first choose one of their favorite fairy tales and select miniatures to represent the story. Any fairy tale may be represented
  • The above image represents the Cinderella story. Cinderella is portrayed to the right. She was the daughter of a loving father and later became a congenial stepdaughter despite the way she was treated. A female sandplayer who may have adopted the Good Daughter role may identify with Cinderella
  • A father and a young daughter are featured in the center of the tray symbolizing the relationship Cinderella had with her loving father, but also symbolizing the safety children feel when they grow up in a nurturing environment. Sandplayers who have or wish they had such a relationship may identify with this miniature
  • The birds surrounding Cinderella and the Prince symbolize friends and companions. There may be sandplayers who may identify with the Friend or Companion role to a sibling or even to a parent. A male sandplayer may identify with the role of the Rescuer within the family and may be drawn to the Prince miniature
  • The Queen miniature symbolizes the evil stepmother. She is surrounded by two leopards, one on each side representing her two daughters, Cinderella’s stepsisters. Sandplayers may perceive themselves or someone in their family to be playing the role of the Queen or Leopard
  • Ask the sandplayers: “What do you know or remember from reading about this character?” How the fairy tale actually unfolds is not as important as how the sandplayer may recall or experience the story
  • Give sandplayers the choice of representing themselves in the scene by either:
    • Adopting the role of one of the miniatures already in the scene, or
    • By bringing a new miniature into the tray. Then ask; “What would this character do or not do?” Stay with the metaphors
  • Has the story changed? What role is the sandplayer now playing? What could be deciphered by the location and sequence of the miniatures?
  • Let us assume the sandplayer might have brought wild animals fighting with each other into the fairy tale activity. In such case, Homeyer and Sweeney (2011) suggest this may qualify as “An Aggressive World,” (p. 41), which may illustrate the sandplayer’s internal fear to expressing anger within his or her family system
  • Give the sandplayer the option to remove any or all of the miniatures from the scene. Homeyer and Sweeney (2011) argue a sandtray is considered an “Empty World” if two thirds or more of the tray has no miniatures” (p. 40). Children who grow up in dysfunctional families where they may feel unheard may come to adopt the role of the Lost Child (Bradshaw, 1988). A Lost Child is likely to create an Empty World sandtray to reflect his or her role in the family

Discussion

Each family has its own traditions, language, culture and routine. The different roles family members may adopt are unconsciously created and implicitly manifested to maintain the status quo and hence, protect an innate and universal fear of abandonment from one’s tribe. The problem with adapting a role is that the role may not be consistent with one’s real Self, but rather a modified self that may have been acquired out of a need to survive one’s environment. Sandtray therapists may become the sandplayer’s fellow traveler, sharing the tools to cope with life’s circumstances and for developing a differentiated Self from those tied to the family system. The goal is not to detach from the family, but to detach from participating in the family drama by refusing to play the roles dictated by a closed family system. Sandplay is a therapeutic tool ideal for symbolic archetypical journeys through the safety of metaphors.

References

Bradshaw, J. (1988). Healing the shame that binds you. Deerfield Beach, FL: Health Communications.

Homeyer, L., & Sweeney, D. (2011). Sandtray therapy (2nd ed.). New York, NY: Routledge.

Kerr, M., & Bowen, M. (1988). Family evaluation. New York, NY: W.W. Norton.

Lowenfeld, M. (1993). Understanding children’s sandplay: Lowenfeld’s world technique. Cambridge, United Kingdom: Sussex Academic Press.

Using Face Painting in Family Therapy

This great intervention idea was submitted by reader Paula Jensen. Ms. Jensen earned a gift certificate to childtherapytoys.com for her submission. Learn how you can do the same!

This is a creative therapy technique that can be used between a parent and child, two or more siblings, or a couple.

Directions:

Materials: Face paint in many different colors; a sheet of pictures/ideas; soap and water for clean-up, and a mirror.

Session length: 60-75 minutes (including clean up).

  1. Each client is allowed about 20-25 minutes to paint a design of their choosing on their family member’s face (e.g. parent paints the child, sibling paints another siblings face).
  2. After face painting is complete, allow time at the end to discuss observations you have made throughout the activity and for clients to process their thoughts and feelings from the experience. It may be necessary to allow processing throughout the activity.
  3. Allow 5 minutes for clean-up.

Notes: Clients may look at their face at the end of each turn or once all clients are complete. Allow the clients to make this decision together before beginning.

Generally, I would allow the client who I perceive to have the least power in the relationship to go first.

Clinical Benefits

  1. It allows insight into what motivates a client’s behaviors in a way that may be difficult to gain through traditional talk therapies.
  2. It opens discussion about how a person interacts with family or loved ones, and how they interact in the world.
  3. It can allow clients to begin processing insecurities or areas in which they feel powerless and may assist them with overcoming some of these internal conflicts.
  4. It provides insight into a parent-child relationship. How the parent and child interact, including how they give and take direction from each other. It can allow the therapist and client to see how comfortable parent and child are with giving up control to the other family member.
  5. It is a fun, non-confrontational, creative way for allowing growth to occur.
  6. It can simply be a bonding experience between the parent and child.

Example:

When I worked as a child and family therapist, I utilized this face painting activity during a mother daughter session. Initially, my goal was to provide a positive bonding experience for the family. Through the out the activity, it came to light that the mother’s self-consciousness about herself interfered with her willingness to try new things and participate in activities with her daughter. This was a big issue between them because the daughter was not receiving the mother-daughter time she desired. In addition, it helped mom express to her daughter how proud she was that her daughter was so outgoing and confident. Through this activity I was able to assist the family with addressing a core issue within their relationship.

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.

Family Drawing Game

Here’s a 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: Activity for assessment of family’s dynamics and communication

Materials needed: One large piece of paper, pack of markers

Appropriate for: A family with young children with whom you will be doing some type of family or play therapy

Directions: Sit family around a table with paper and markers.Tell family “I am only going to give you the rules to this activity one time.I will give a marker to one person.That person will make one line on the paper, then choose a marker and give it to the next person to make one line.This will continue for 15-20 minutes.”Try to give as little extra information as possible, so that the family will interpret the rules.While the family is drawing, reflect on choices or interpretations the family members are making.Afterwards, ask each family member their thoughts on the process or reflections made during drawing.Also reflect on the drawing as a whole.

Observations that could be important while drawing: There will often be a first person who breaks a rule, such as making a second line, which will prompt someone else to tattle on them.This can often signal tensions between members who try to maintain control in the family.There could also be a person who is strictly trying to adhere to the rule or someone who tries to control what others are doing to the drawing, asking them to change the color or order of family members chosen.

Interpreting the drawing itself: A family that does not communicate well or has broken relationships will often have separate areas in the paper, whereas members that get along will feel comfortable building on one another’s lines.If a family desires to work together, they will often listen to others’ suggestions or try to go with other members’ ideas.For example, if someone has made bunny ears on a line, another might add eyes or a nose.In contrast, some families will try to change one another’s pictures and something that started as a bunny may be turned into an alien.This could signal a need to one-up or annoy the other person.Some people will also add things to the drawing to try and push the therapist or family member’s limits, like making a cute bunny into a zombie assassin bunny.Finally the amount to which the different family members try to make the picture into something can be a sign of their creativity or problem-solving skills.The picture usually starts out abstract, but as the picture proceeds, more flexible and creative families tend to try to bring some order into the drawing, by making the lines into something concrete or at least connecting the abstract lines in some type of order.

Family Environment and Children’s Behavioral Disorders

This contribution is from Martha Nodar, who earned a $100 gift certificate to childtherapytoys.com. Learn how you can do the same!

Family Environment and Children’s Behavioral Disorders

Confounding influences such as family environment may have a significant role in children’s disruptive behaviors at home and at school, which may continue and worsen by the time they reach adolescence (Green & Gibbs, 2010). Green and Gibbs (2010) are referring to parental discord, divorce, neglect, verbal abuse, corporal punishment, parental substance abuse, and poor or inconsistent parenting skills as examples of family environments conducive to children’s disruptive behaviors. Poor or inconsistent parenting skills may include subscribing to an unreliable disciplinary paradigm, such as disciplining the child according to the parents’ mood at the time. Green and Gibbs (2010) also include “harsh punitive discipline,” such as “scolding, spanking, restraining, grabbing” (p. 227) as triggers of disruptive behaviors in children. However, they cite “humiliation or contempt” (pp. 227-228) as the types of abuse responsible for inflicting the most psychological damage in children and the antecedent of most disruptive behaviors. This paper advances the current literature by offering a perspective on different forms of intervention and the implications for school counselors and therapists.

Social impairment is the hallmark of behavioral disorders, which may encompass shouting at teachers or parents, kicking siblings or classmates, and the inability to play with peers. Green and Gibbs (2010) argue that “repressed hostilities and rage” (p. 226) as the result of perceived deficits in nurturing may be the underpinning driving the children’s disruptive behaviors. These scholars suggest that most of the time disruptive behaviors emerge during the preschool years when the children come in contact with their peers. Drawing from their experience, Green and Gibbs believe there is a relationship between how children may behave with others and the type of attachment they may have formed with their primary caregiver, who in many instances may be the mother (Bowlby, 1988). Insecure attachment (avoidant or withdrawn), elicited by perceived inconsistent care, tends to trigger children’s reliance on “primitive structures” such as kicking and screaming, rather than using social skills (Green & Gibbs, 2010, p. 228).

Based on a 2012 study that Duncombe, Havighurst, Holland and Frankling conducted with 373 children between the ages of 5 and 9 years-old, they found that parents’ mental health; a habit of dismissing their children’ s emotions such as sadness, “inconsistent parental discipline and corporal punishment are associated with the development of serious problem behavior” (p. 728). In particular, inconsistent parental discipline is the one especially correlated to disruptive behavior disorders. When these disruptive behaviors continue to escalate as preschoolers start grade school, some children may be diagnosed with Attention Deficit/Hyperactivity Disorder (ADHD). Attention Deficit Disorder (ADD) is usually the diagnosis given to children with mild ADHD. Leisman et al. (2010) cite ADHD as “the most common neurobehavioral disorder in childhood” (p. 283). Inattentiveness, being easily distracted, unable to sit down for any period of time, social impairment, and physical impulsivity are some of the characteristics found in both ADHD and ADD. These characteristics range from mild to severe in both ADD and ADHD depending on where they may fall in the spectrum.

Pfiffner,McBurnett, Rathouz, and Judice (2005) argue that disruptive behaviors in children with ADD/ADHD are likely to be not only triggered but also exacerbated by family dynamics. In order to find support for their theory, Pfiffner et al. (2005) assessed 149 children between the ages of 5 and 11 years-old who had been diagnosed with ADHD, and their parents. Grounded on their findings and in agreement with some of Green and Gibbs’ (2010) arguments, Pfiffner et al. cite paternal antisocial behavior; punitive or inconsistent parenting style, and lack of parental warmth in their interactions with their children, as examples of a family environment that may precipitate behavior disorders in their offspring with or without ADD/ADHD.

Although disruptive behaviors are a symptom of ADD/ADHD, not all children with disruptive behaviors have ADD/ADHD. Recent research points to the notion of a behavioral continuum range where normative behaviors of young children are found at one end of the behavioral landscape, and those behaviors that fall outside the normative range are clustered toward the opposite end of the spectrum. In a pioneer study, Wakschlag et al. (2007) examined the quality of behavior of preschoolers (the pervasiveness, intensity and frequency of the behavior) to determine what they refer to as “clinical discrimination” (p. 976). This means, for clinicians to have the ability to discern what falls inside or outside the normative range of behaviors observed in young children.

Download the entire article here.

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.

Family Portrait Intervention Technique

Liana Lowenstein’s website (www.lianalowenstein.com) is full of great articles, resources, and other useful information for play therapists. She recently posted a new featured technique called Themed Family Portraits in which each family member is asked to create a picture of their family and come up with a theme for the picture. Then each member shares their picture with the rest of the family, encouraging discussion and communicating the perspective and thoughts of each individual family member.

I highly recommend subscribing to Lowenstein’s newsletter, and also (if you haven’t already) including her invaluable books in your office library. Here’s a list of what she’s published, all available at ChildTherapyToys.com.

Creative Interventions for Troubled Children & Youth – This best-selling collection is filled with creative assessment and treatment interventions to help clients identify feelings, learn coping strategies, enhance social skills, and elevate self-esteem. A wealth of practical tools. For ages 4-16 in individual, group, and family therapy.

MORE Creative Interventions for Troubled Children & Youth – Presents MORE creative interventions to engage children, youth, and families in counseling and help them address treatment issues such as feelings identification, anger management, social skills, and self-esteem. Includes techniques to manage challenging client behavior. A great sequel to Liana Lowenstein’s last best-selling book. For ages 4-16 in individual, group, and family therapy.

Creative Interventions for Bereaved Children – A uniquely creative compilation of therapeutic games, art activities, and stories to help bereaved children express feelings of grief, learn basic concepts of death, diffuse traumatic reminders, address self-blame, commemorate the deceased, and learn coping strategies. Includes special activities for cancer, suicide, and homicide, and tips for caregivers and school personnel.

Creative Interventions for Children of Divorce – An innovative collection of therapeutic games, art techniques, and stories to help children of divorce express feelings, understand marriage and divorce, deal with loyalty binds, parental conflict, and reunification fantasies, address self-blame, and learn coping strategies. Includes tips for parents, and a ten-week group counseling curriculum. For ages 7-12 in individual, group, and family therapy.

Assessment and Treatment Activities for Children, Adolescents, & Families – In this comprehensive resource, Liana Lowenstein has compiled an impressive collection of techniques from experienced practitioners. Interventions are outlined for engaging, assessing, and treating children of all ages and their families. Activities address a range of issues including, Feelings Expression, Social Skills, Self-Esteem, and Termination. A “must have” for mental health professionals seeking to add creative interventions to their repertoire.

Creative Family Therapy Techniques: Play, Art, & Expressive Activities – Edited by best-selling author Liana Lowenstein, this books presents a unique collection of family assessment and treatment interventions. This practical resource illustrates how play, art, drama, and other approaches can effectively engage families in therapy and help them resolve complex problems. An exceptional tool for the seasoned family therapist, as well as the newly licensed practitioner. this book contains innovative ideas that can be readily and quickly implemented for involving children in family therapy sessions.

Assessment and Treatment Activities for Children, Adolescents, and Families: Volume Two – In this second volume, highly acclaimed author Liana Lowenstein has compiled an impressive collection of techniques from experienced practitioners. Interventions are outlined for engaging, assessing, and treating children of all ages and their families. Activities address a range of issues including, Feelings Expression, Social Skills, Self-Esteem, and Termination. A “must have” for mental health professionals seeking to add creative interventions to their repertoire.