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Demystifying Play therapy: Play ought to be taken more seriously

Demystifying Play therapy: Play ought to be taken more seriously

Written by: Dr B. Malavika, Psychological & Educational Therapist

Play is a critical part of a child’s development from birth. It boosts healthy brain development that is conducive for physical, cognitive, and emotional growth. It encourages imagination and creativity, and improves social skills and confidence. It is therefore not surprising that psychologists realised its power and tapped into it as an instrument of healing.

Challenges are a part of life. But in childhood, they can be harsher as children haven’t developed the capability to understand or deal with what they are going through.  In their tender minds, loss or pain could be something as small (to an adult) as a broken favourite toy and range up to a major loss in the forms of death, separation from a loved one,  hospitalization, abuse or other personal/family crises. While some children might manage to some extent by voicing their displeasure or through negative behaviours, others might just suppress their emotions. If the setbacks are beyond the coping skills of the child, the trauma can manifest as psychological or emotional disorders.

Parents often ask how they can know if their child needs counselling.  Some signs could be that the child is being more angry, nervous, defiant, sad, or withdrawn than usual, or than is reasonable. The child could also be showing changes in eating and sleeping patterns, a decrease in school grades or reduced interest in previously favoured activities. When in doubt, it is better to err on the side of caution and seek help.

Play therapy is one of the prominent forms of therapy for children and is practised by a variety of mental health professionals, like counsellors, psychotherapists, clinical psychologists, psychiatrists and social workers. It is an intervention which allows children who are experiencing emotional or behavioural issues to open up their emotions in the safe space of the ‘playroom’.  They are given toys to play with, and the children play as they wish, without feeling interrogated or threatened.  For the children themselves, play (therapy) is familiar and fun and they are thus able to work out their undesirable experiences and resolve their emotional and behavioural difficulties. What materials the child chooses to play with and how they play all have meaning.  The therapist watches their play to get an insight into their emotional or mental health problems. 

Depending on the issues faced by the child and their own training, therapists conduct non-directed or directed play therapy and provide play materials accordingly. Non directed play therapy is free-play and very similar to the free association of adult psychodynamic therapy. While in the latter adult clients are allowed to talk and ventilate to gain insight and resolve their problems, free play with limited conditions and guidelines, allows the child to express their feelings just through their play. Their verbal expression might or might not be as important.

Directed play therapy includes more structure and guidance by the therapist and several techniques are used to purposefully engage the child. These could be engaging in play with the child themselves or suggesting new topics, themes for play. Parents might or might not be included in the sessions. Materials may include art and craft materials, sand and water, clay, dolls, toys, blocks, a family of dolls, miniature figures, animals, musical instruments, puppets and books. While traditionally Play therapy is considered to be beneficial for children ages  3 to 12,  it has been modified and customised by researchers and therapists to help adolescents and adults also, and some mental health practitioners have started including video games as therapeutic tools. Apart from being used at counselling centres, play therapy is also being used at critical-incident settings, such as hospitals and domestic violence shelters to help children deal with deep issues. 

In regular lives, parents can encourage their kids to play indoors and outdoors and especially in nature. Lawrence J. Cohen has created an approach called ‘Playful Parenting’, in which parents are encouraged to connect playfully with their children through silliness, laughter, and roughhousing to enhance relationships and general well being.

Challenges are a part of life. While the purpose of therapy is to solve problems, playing for the sake of fun can prevent them. This can be applied not only for children but for the inner child in every individual to make life happier and more meaningful. As the proverb goes – All work and no play makes Jack a dull boy.

 


Photo by Caleb Woods on Unsplash

An interview about Children with ADHD on Vasantham’s En Ullae S2 with S C Anbasaru

An interview about Children with ADHD on Vasantham’s En Ullae S2 with S C Anbasaru

Vasantham (Mediacorp’s Tamil & Hindi TV Channel) studios reached out to Promises Healthcare’s Senior Clinical Psychologist, S C Anbarasu, in the name of bringing greater mental health awareness to the Indian community in Singapore.

In En Ullae S2 episode 9, we are introduced to an exuberant boy, who upon closer inspection is revealed to suffer from Attention Deficit Hyperactivity Disorder (ADHD). Is he beset by developmental issues, or is there a more benign explanation? Senior Clinical Psychologist S.C. Anbarasu opens the episode with a parsimonious explanation of ADHD – simply, people with ADHD are distinguished by a lack of ability to pay attention, and appear to have vast amounts of energy, hence, ‘hyperactivity’.

In a dramatisation, the boy’s mother wears an expression of bemused exasperation – the problems began even before his birth. Prolonged labour (which occurs after 18 –  24 hours), and a possible Caesarean section heralded the coming of a “problem child”. Anusha Venkat then recalls how, at the age of 2 or 3, she came to the realisation that her son’s inability to focus was far more prevalent than what she observed in other children. Even a couple of seconds of concentration seemed to be a hard ask. He couldn’t remain placated long enough to complete any task. At the childcare, teachers baulked at how he pinged from corner to corner of the room. 

Anusha reveals how a serendipitous discovery that Carnatic music could calm him down enough to remain in one spot for more than 10 minutes. A breakthrough! Anbarasu explains that while a child suffering from ADHD can disrupt classroom proceedings, it is pointless to use force to discipline them. ADHD can make someone feel like they are “constrained within a container” if they are impelled to do a task in which they have no interest. Instead, they expend their energy reserves by indulging in some other activity – like running around and being a little menace. For parents who are unaware of ADHD as a mental health condition, seeing their child act out can be scary. In fact, Seelan (the boy protagonist) went undiagnosed at age 3 – doctors merely offered that most children are, well, rambunctious tots at that age. It takes a diligent parent to make a reasoned conclusion that their child may suffer from ADHD. Seelan was given assorted tasks to complete, with his attention span closely watched, even who he liked or disliked in class was logged. 

 

(Click on the link for a version with English subtitles. Remember to click on the ‘Settings’ button to reveal the English subtitle selection. https://www.mewatch.sg/en/series/en-ullae-s2/ep9/958092)

However, Anbarasu recommends that care must be taken to conduct a diagnosis per the Diagnostic Statistical Manual (DSM-5). First, the test must be conducted on children below the age of 12. While school-going children come with a larger raft of observable behaviours due to differences in environment (home, school, etc), Anbarasu admits that is is not easy to chalk up roughhousing or rowdiness to ADHD when those are developmentally appropriate behaviours for a child. Apparently, six or seven are ages when an accurate diagnosis is reached easiest. 

Aside from Carnatic music, Seelan’s attention span was helped by repetitive menial tasks like peeling potatoes, chopping ladies’ fingers and carrots. Anbarasu acknowledges that dealing with ADHD in children is a time-consuming task because they aren’t able to complete tasks as quickly as their peers. He calls on parents to pick up the slack – strategising holistic ways to help their child, both at home and in school. It’s a collaborative effort between teachers and parents to then carry out an agreed-upon strategy.

All is not doom and gloom, however. Seelan is observed to play with Lego building blocks for hours on end, despite not performing in the classroom. Anbarasu calls this ‘hyper-focus’. It is a state of mind wherein the mind eliminates noise that potentially distracts them from the task at hand, a sort of “perk” if you will. We are cautioned that encroaching upon this state of hyper-focus can exacerbate emotional issues and precipitate anger. People with ADHD are victim to ‘emotional dysregulation’, which may manifest from frustration in perceived inability to complete tasks satisfactorily. Seelan was unable to appreciate the benefits of delayed gratification, getting restless and upset if things didn’t go his way. Anbarasu explains that this results from emotional dysregulation as well.

At some point, Seelan faces potential expulsion from his class due to the complaints of other children’s parents. Especially in Singapore, where grades are paramount, a poor academic performance which results from an inability to work with a child’s ADHD can be distressing to parents. The teeth-gnashing frustration can make parents feel helpless, and Anbarasu suggests that these situations call for a consultation with a professional therapist who will elucidate the behavioural issues at hand. This gives parents more information to plan future steps. Parents of children with ADHD also attract stinging criticism from other parents. They might feel inadequate in their roles as nurturers and mentors. Anusha has accepted this to be a part of life, chortling as she muses that “you can’t change people”. Whatever the case, it isn’t fair to fault parents for a child’s ADHD. Or the child. Anbarasu clarifies that ADHD is a neuro-developmental disorder – in other words, that’s just how the cookie crumbles. Blame should not be apportioned. Anusha recalls how Seelan used to behave like an attention hog – in its absence, tantrums would be the order of the day. According to Anusha, dealing with instances of emotional dysregulation like this is challenging, especially if you have to deal with the needs of your child while observing social propriety. 

Every child’s circumstances are different, so Anbarasu recommends that care be taken to evaluate if danger is imminent. Shouting for a little is perfectly OK. Deal with them after they have thrown their fits because anger is not conducive to receptiveness to advice. Anbarasu is careful to eschew the notion of a “cure” for ADHD. Rather, he says that it is “treatable”. Whether with medication or psychotherapy, or a combination of the two.

Children with ‘combined-type’ ADHD are challenged in a triune of areas – attention, hyperactivity and impulsivity. For these cases, neuropharmacological support is required, to aid concentration and retention of information in class. If the ADHD is not as pronounced, therapy alone could manage the condition. For parents who are especially harrowed by their child’s condition, they should know that there is ample evidence in favour of managing ADHD through the concurrent administration of medication and therapy. On top of psychiatric interventions, there are support groups inside and outside the classroom for parents who are overly stressed.

The episode closes with the narrator speaking over clips of Seelan looking positively cherubic. The viewer is called on to spare the snide remarks, replacing them with positivity, understanding, and “plenty of support”. 

Children & Youth Bullying: How to Spot and Address it

Children & Youth Bullying: How to Spot and Address it

By Tan Su-Lynn, Educational Psychologist

Bullying can be manifested in many forms, and children and youth can be involved in many ways in it. However, with 1 in 4 children in Singapore reporting that they have experienced bullying a few times a month, bullying might be closer to home than you think. 

Bullying is done with the intent to hurt and is repeated or persistent. Often, the target of bullying finds it difficult to stop it or stand up for himself / herself. This is different from peer conflicts or quarrels which typically involve incidents where children mutually hurt each other. As parents and caregivers, how do we support our children as they navigate the complexities of relationship-building, and what are some warning signs that indicate that they are involved in bullying? 

 

Broadly, there are three different types of bullying

  • Relational: When hurtful actions are made with the intention to shame a person and damage the forming of healthy relationships and friendships. This can take the form of leaving someone out of a group, teasing, name-calling, expressing negative thoughts or feelings about a person, and even intimidating them to do things against their will.

 

  • Physical: When harm has been inflicted on a person or their belongings. This can take the form of hitting, punching, kicking, inappropriate touching and persistent damaging or stealing of belongings.

 

  • Cyber-bullying: Occurs on the internet, through mobile phones, computers, video-game systems and other forms of technology. Both relational and physical bullying can occur on this platform. For example, digital technology can be used to gossip and spread rumours or hostile messages, or game accounts can be hacked and items stolen. 

 

How do I identify if my child is involved in bullying?

Recognising these warning signs is the first step in stemming bullying. 

Warning signs of being a target of bullying:

Your child…

  • has unexplainable cuts, bruises, scratches or other injuries
  • comes home with lost, torn, damaged, or destroyed clothing, books, stationeries or other belongings 
  • is unusually hungry after returning from school
Physical Signs
  • seems fearful of going to school, walking to and from school, riding the school bus, or taking part in organized activities with peers, and often finds or makes up excuses (e.g. faking illness) as to why he/she cannot go to school
  • has declining grades, lost interest in school work or suddenly begins to do poorly in school
School-related signs
  • experiences a loss of appetite, or has changes in eating habits like skipping meals or binge eating
  • reports sleeping difficulty (e.g. trouble falling and staying asleep, frequent bad dreams, etc)
  • complains frequently of headaches, stomachaches or other physical ailments
Health signs
  • suddenly stops talking about friends and has few, if any, friends, with whom he or she spends time with during recess or after school
  • is withdrawn and stammers
  • continually ‘loses’ money or starts stealing
  • appears anxious, sad, moody, teary, or depressed when he or she comes home and suffers from low self-esteem 
  • self-harms or talks about suicide
  • becomes aggressive and unreasonable
  • refuses to talk about what is wrong
  • begins to target siblings
Emotional and Behavioural signs

 

Warning signs of engaging in bullying:

Your child…

  • gets into verbal or physical fights
  • suddenly possesses unexplained extra money or new belongings
  • often reacts aggressively towards others
  • has friends who bully others
  • may be excessively worried about their popularity and reputation
  • can be competitive
  • has received many disciplinary warnings and actions 
  • refuses to accept responsibility for their actions 
  • blames others for their problems
  • experiences anxiety or depression
  • has difficulty regulating his/her emotions and behaviour
What should I do if I think my child is involved in bullying?

It is important to talk with children who show signs of being bullied or bullying others. The safety and mental health of our children should remain an utmost concern. It’s painful to think of your child receiving or inflicting harm on other kids, but bullying is a serious issue for both the targeted and the aggressor. According to research, a vast majority of bullies have also been the targets of bullying, and less than 1% of primary school children are “true bullies” – those who were not bullied by their peers.

Bear these three C’s in mind when relating with your child: Communicate, Consult and Connect

  • Communicate
    If you hear from a teacher or another parent that your child involved in a bullying situation, the first thing you should do is talk to your child about the situation. Be direct about the issue, but make it clear that you are open to hearing your child’s side of the story. Stay calm and say something like, “Your teacher called to tell me that you were involved in some bullying. I’m really concerned about this, and we need to talk about it. Please tell me what happened.”Avoid prejudging the situation and reacting based on emotions. It can be tempting to immediately blame the other party, criticise parenting, or condemn the school system, but it is also worth taking time to look inward and reflect on whether your own actions may be influencing your child’s. Some children may be modelling their interpersonal style based on the behaviour they have observed. If so, it is important to start fostering a positive home environment, where members of the family treat one another with kindness and respect, creating a safe space for children to share their worries and failures.

 

  • Consult
    Talking through the situation with your child can help you understand why the bullying is happening, and what steps need to be taken in order to stop it. For example, you may find that your child has incredibly low self-esteem and bullying helped him/her feel powerful and able to control something. He/she might prefer being known as ‘the worst kid in school’ and interacting with other children in the process, rather than not being noticed at all and having no friends. Or perhaps your child might accept being the target of bullying with the mistaken belief that such behaviours are acceptable between friends. Some children may not be able to articulate their feelings. This is especially true of children who are struggling with anxietytrauma, or another mental health issue. If you are having trouble, consider consulting a child psychologist or psychiatrist who has a lot of experience evaluating kids’ behaviours. Your child might need a therapist’s help to work through underlying issues, investigate the root of the problem and guide you and your child in tackling the specific challenges that your child faces in his/her social interactions. 

 

  • Connect
    Ultimately, it is about building a close and lasting connection with your child. Connecting with your child about his/her day-to-day life will put you in a better position to recognise signs of bullying and trouble. Start with asking your child a few open-ended questions on a daily basis. For example, ask him/her to share about one really great thing that happened that day, and one not-so-great thing. It can be tough to get started, but children who are regularly encouraged to share details of their lives with their parents tend to be more comfortable with continuing to do so when they are in their adolescence. Listening to your child in a supportive, non-judgmental way helps them feel connected to your presence and love in their lives, and makes them more receptive to opening up to you about their problems as well as accepting the advice that you give to them. It is always better to handle challenging issues like bullying together so that your child will be able to walk out of the shadow of the bullying with confidence and courage.

 


Reference

1 https://bullyfree.sg/wp-content/uploads/2018/12/The-Straits-Times_Bullying-in-schools-stable-and-managed.pdf, https://mothership.sg/2019/12/bullying-singapore-pisa-2018/

2 https://www.theguardian.com/education/2008/aug/29/bullying.schools2