The Feeling Word Game

Therapeutic Rationale

Often children have difficulty verbalizing their feelings when directly questioned, either because they are guarded or they do not connect with those feelings they find most threatening. When involved in playing a game, children’s defenses are reduced, and they are more likely to talk about their feelings. The Feeling Word Game (by Heidi Kaduson; for details, see Kaduson & Schaefer, 1997, pp. 19 –21) allows children to communicate their feelings in an enjoyable, nonthreatening manner.

Color-Your-Life

Therapeutic Rationale

Color-Your-Life (O’Connor, 1983) provides children with a nonthreatening, concrete method of understanding and discussing various affective states. It is critical for children to develop certain skills to successfully manage their affect. Specifically, children need to develop an awareness of numerous affective states, the ability to relate those states to their environmental events, and the skill to verbally express these feelings in an appropriate manner.

Description

Materials needed: a coloring instrument (i.e., crayons, colored pencils, paint, or chalk) and white paper. The therapist begins by asking the child to create various color– feeling pairs. For example:

Therapist: Can you tell me what feeling might go with the color red?

Child: I don’t know.

Therapist: Think of a time when people scrunch up their faces and get very red.

Child: Oh, when they get mad!

Therapist: Good job. Many people think that the color red matches

being angry.

Balloons of Anger

Therapeutic Rationale

It is crucial to help children understand what anger is and how to release it appropriately. Balloons of Anger (by Tammy Horn; see Kaduson & Schaefer, 1997, pp. 250–253) is an enjoyable, effective technique that provides children with a visual picture of anger and the impact that it can have upon them and their envi- ronment. It allows the children to see how anger can build up inside of them and how, if it is not released slowly and safely, anger can explode and hurt themselves or others.

Description

Materials needed: balloons.

1. First, the child blows up a balloon, and then the therapist helps tie it. 
2. Second, the therapist explains that the balloon represents the body, and that the air inside the balloon represents anger.

3. Third, the therapist tells the child to stomp on the balloon until it explodes and all of the anger (air) comes out. Fourth, the therapist explains that if the balloon were a person, the explosion of the balloon would be like an aggressive act (e.g., hitting a person or object)

The Mad Game

Materials needed: cardboard, wooden, or plastic blocks.

The therapist divides the blocks evenly between himself or herself and the child, with the instructions that each person will place a block atop the previous one when it is his or her turn. They alternate turns, each time expressing something that makes him or her angry or something that is not fair. All statements are accept- able, from silly to serious. The therapist begins by bringing up fairly benign issues that the child has and progresses to specific issues of therapeutic concern. For example, “It makes me angry when adults hit children” (abuse). Once all of the blocks are stacked, the child is asked to think of one thing that makes him or her really angry, to make a “mad face,” and to knock down the blocks.

Beat the Clock

Beat the Clock (by Heidi Kaduson; see Kaduson & Schaefer, 1997, pp. 139 –141) was designed to increase children’ s self-control and impulse control. The goal of this game is for the child to resist distraction, remaining on task and focused for a specified period of time. When the child successfully completes this task, she or he receives poker chips, which can be cashed in for a prize. When the child is successful at the game, the child is filled with a sense of competence and accomplishment.

Materials needed:

Kitchen timer, poker chips, drawing materi- als, blocks, and easy reading books.

Applications

Beat the Clock can be used in an individual or a small group format. This technique is useful for any child who has impulse- control problems (e.g., children with ADHD). Swanson and Casar- jian (2001) described a comparable version of Beat the Clock in which the child is engaged in school-based activities. Common techniques that have a similar goal include Statue (i.e., the child is to remain motionless) and Make Me Laugh (i.e., the therapist tries to make the child laugh and vice versa).

Relaxation Training: Bubble Breaths

Therapeutic Rationale

Bubble Breaths (by Neil Cabe; see Kaduson & Schaefer, 2001, pp. 346 –349) is an extremely useful and concrete relaxation tech- nique designed to teach children deep and controlled breathing while helping them become aware of their own mind–body con- nections. Bubble blowing is fun, inexpensive, and allows non- threatening interactions between the child and therapist.

Appilication:

The children are asked to blow only one big bubble. The therapist teaches the children to take deep breaths from the stomach and slowly exhale. Next, the therapist explains to the children that when they become angry or anxious, the brain wants more air, but the lungs are working too hard being upset to provide it. However, if they breathe deeply, their brain will tell their heart to slow and the lungs will work better. The therapist then tells the children that if they take bubble breaths when they start to become angry, nervous, or tense, they can often prevent angry behaviors from happening.

Worry Can

Therapeutic Rationale

Children often worry about numerous things that they keep bottled up inside. These worries may be the root of some of their presenting problems, such as fears, peer conflict, temper tantrums, and separation anxiety. Worry Can (by Debbie S. Jones; see Kaduson & Schaefer, 1997, pp. 254–256) is an effective method for helping children to identify and then discuss their worries with an adult and/or other children.

Description

Materials needed: a reclosable can, colored paper, markers, glue, and scissors.

The child is instructed to write down his or her worries on separate pieces of paper and then to place the strips of paper into the can. The child should then share some worries with the therapist or with other children if the activity is conducted in a group.

Party Hats on Monsters

Therapeutic Rationale

Party Hats on Monsters (by David A. Crenshaw; see Kaduson & Schaefer, 2001, 124 –127) is a drawing strategy designed to enable children to gradually face their fears in a nonthreatening, enjoyable manner. Most children find it more comfortable to express their fears through drawing as opposed to verbalizing them. Further- more, children find it reassuring when they are not required to face their worst fear or anxiety immediately. By experiencing step-by-step success facing the feared object, the children’s confidence and sense of mastery are increased.

Weights and Balloons

Therapeutic Rationale

A common challenge in therapy is making abstract therapeutic constructs understandable, meaningful, and concrete to children. Techniques that are enjoyable and “hands-on” are an ideal way to teach children these complex concepts. Weights and Balloons (by Celia Linden; see Kaduson & Schaefer, 2001, pp. 115–117) is an easy, effective technique for teaching children the somewhat com- plicated cognitive–behavioral theory of depression.

Description

Materials needed: a dozen helium balloons, paper and pen, and some type of weight (e.g., rocks, blocks, etc.).

• The therapist and the child create a list of negative and positive thoughts that the child has about a specific situation or in general. 
• the therapist assigns each negative thought a weight and each positive thought a balloon. 
• The therapist then demonstrates how it feels to hold each of the objects The therapist has the child hold all of the weights and walk around the room with them. This helps the child see how holding onto one’s negative thoughts weighs one down

The Power Animal Technique: Internalizing a Positive Symbol of Strength

Therapeutic Rationale

Children who are referred for therapy often have low self- esteem, ineffective problem-solving skills, and difficult relation- ships with peers and adults. Therefore, primary therapeutic goals often include improving the child’s positive sense of self and increasing his or her coping skills. However, it is often difficult for children to articulate what strengths they wished they had or what attributes would help them cope more effectively. The Power Animal Technique (by Deborah A. Hickey; see Kaduson & Schaefer, 2001, pp. 451–454) provides children with an imagina- tive and enjoyable method of internalizing those strengths and attributes that they desire.

Using a Puppet to Create a Symbolic Client

Puppets serve a crucial role in play therapy. Frequently, children project their thoughts and feelings onto puppets. In this way, puppets allow children the distance needed to communicate their distress. Furthermore, the puppets serve as a medium for the therapist to reflect understanding and provide corrective emotional experiences in the context of the children’s play. Most children naturally project their experiences onto the puppets. However, some children are too fearful and withdrawn to become involved in any aspect of therapy. By using the puppet as a symbolic client (a game created by Carolyn J. Narcavage; see Kaduson & Schaefer, 1997, pp. 199–203), the therapist is able to engage these children and overcome resistance. The creation of the symbolic client removes the focus from the child, thereby increasing the child’s comfort level and allowing him or her to remain at a safe emo- tional distance.

Broadcast News

Therapeutic Rationale

It is much easier for children to play out their problems than discuss them. Furthermore, children are better able to solve their own problems when they can distance themselves from them. Broadcast News (by Heidi Kaduson; see Kaduson & Schaefer, 2001, pp. 397– 400) is an enjoyable, nonthreatening technique that enhances children’s verbalization and problem-solving skills.

The Spy and the Sneak

Therapeutic Rationale

The Spy and the Sneak (by Bria Bartlett-Simpson; see Kaduson & Schaefer, 1997, pp. 163–164) was designed to transform nega- tive family interactions into positive ones, which would increase the family members’ enjoyment of each other and improve their self-esteem. Parents begin to see many of their children’s positive qualities and start to reward the good behavior. Children realize that they get more attention by acting in a positive manner than in a negative one.

Butterflies in My Stomach

(Lowenstein, 1999) The therapist introduces the activity by pointing out that everyone has problems and worries. Different ways the body reacts to stress are outlined. For example, when people are scared, their heart might pound faster, or when they are sad and about to cry, they might feel like they have a lump in their throat. The therapist then asks the client if he or she has ever heard of the expression “I have butterflies in my stomach.” If the client is unfamiliar with the expression, the therapist offers an explanation, such as, “When you are worried or nervous about something, your stomach might feel funny or jittery, as if you have butterflies in your stomach. You don’t really have butterflies in your stomach; it just feels like you do.”

The Way I Want It to Be

(Lowenstein, 2002) The client draws two pictures, the first on a sheet of paper titled “The Way My Life Is” and the second on a sheet of paper titled “The Way I Want It to Be.” The client then discusses the two pictures. The therapist can ask the following process questions:

• How did you feel during the drawing activity? • How are you going to get from the way it is to the way you want it to be? • What do you need to do differently to get to the way you want it to be? • How might therapy help you get to where you want to be? • How will you feel when you get to where you want to be?

Can You Kazoo?

(Chalker, 2010) The therapist and child each choose a kazoo. The therapist hums a rhythm or tune on one kazoo and the child tries to repeat it. If the child repeats it correctly, he/she chooses a treat or sticker. Then the client hums a rhythm or tune on his/her kazoo. The therapist repeats it correctly and chooses a treat or sticker. The therapist starts out with simple rhythms and increases the complexity as the child becomes more adept at repeating them. The therapist sets a number of turns for each person or lets the child decide when to end the game.

Click! Emotions

(Adapted from Cotnoir, 2008)

This intervention helps children identify and express feelings. The therapist and child brainstorm a list of feelings. The child is then asked to facially express each feeling, and to hold the facial expression while the practitioner takes a picture of each facial expression. The child then identifies times he/she felt the depicted feeling.

Feelings Mish-Mosh

(Adapted from Crisci, Lay, and Lowenstein, 1997) Introduce the activity by stating, "Everyone has feelings--comfortable feelings like happy and excited, and uncomfortable feelings like sad and scared. It is normal and okay to have all kinds of feelings. Sometimes we feel confused or mixed up because we have so many different feelings. The therapist and child take turns talking about times when they felt happy, sad, mad, and scared. As the feelings are shared, the therapist opens the bag and slowly pours the liquid out into a sink or a cup, thus metaphorically letting out the feelings. At the end, exclaim, "We let out our feelings and now we don’t feel filled with a mish-mosh of mixed-up feelings!"

Identifying the Outcomes of Past Traumatic Experiences.

Therapists need to identify signs and symptoms that may represent effects of trau- matic experiences and assess for impairment in children’s cognitive, emotional, and social functioning. It is particularly important to assess those children who have experienced sexual or physical abuse, or expo- sure to domestic violence to determine if they are exhibiting symptoms of PTSD or depression

Determining the Primary Behavioral Response.

The final step of assessment using the Trauma Outcome Process model is to identify which of the options in the Trauma Outcome Process is the child’s primary behavioral response. Figure 2 illustrates the Trauma Outcome Process of children with sexually abusive behavior problems (Rasmussen, 1999). Children who have been traumatized may show internalizing symptoms, externalizing symptoms, or both. Although they may enact both self-destructive and abusive responses in the Trauma Outcome Process, it is usually possible to determine which of the two responses is the most salient. Determining the primary behavioral response establishes the initial focus of treatment (Rasmussen, 1999).

Awareness of Cognitive Processes Teaching

Children with sexually abusive behavior problems to recog- nize, identify, and correct thinking errors helps increase their awareness of their thought processes. Cognitive-behavioral techniques can also help children understand their motivation for engaging in sexually abu- sive behavior and formulate a relapse prevention plan (Burton et al., 1998; Gray & Pithers, 1993). A simple technique for teaching about thinking errors involves posting a chart in the therapy room listing com- mon thinking errors (e.g., blaming, excuse making, minimizing, lying, assuming) and ways to correct them. When therapists notice children using thinking errors in sessions, they can ask them to find their think- ing errors on the chart and discuss how to correct them. Although young children under age 8 may not understand some thinking errors, most do understand the thinking errors of lying, blaming, and excuse making. Charts for younger children should list only those three thinking errors (Burton et al., 1998). 

Interviewing the Child.

The focus of individual interviews with chil- dren with sexually abusive behavior problems is twofold. First, thera- pists need to help children feel safe enough to admit their involvement in sexual behavior problems and to begin discussing their feelings and the circumstances surrounding each incident. Second, therapists must assess children’s emotional, cognitive, and behavioral functioning, par- ticularly signs and symptoms that may be effects of prior traumatic experiences. Therapists should ensure that children feel somewhat comfortable talking in therapy before asking them to disclose their sex- ually abusive behavior and to reveal details about the circumstances related to each incident.