Photo by Kristina Sargent.
by Kristina Sargent, MSW, LISW-S
As a fresh-out-of-graduate-school social worker, I remember being open and excited about the opportunities ahead. The sky seemed to be the limit in all the prospects social work offered, and after passing my licensure exam, I was willing and ready to explore the vast and diverse landscape of social work as my career. After noticing a posting for an early childhood mental health specialist, I reviewed my child development class notes and had a successful interview for the position. However, I quickly felt unprepared for and was challenged by how to apply the theoretical concepts and interventions I learned in graduate school to the young children on my caseload.
- What are the stages of change for a 5-year-old?
- Is it possible to use Cognitive Behavioral Therapy with a pre-schooler?
- How can I teach a lower functioning 4-year-old about “deep breathing” when the child does not even understand that terminology?
It didn't take me long to realize that the social work principle of “meeting clients where they are” would require further training and some visits to yard sales and toy stores.
When we understand the brain and its development, we realize that children learn through experience. Just as young animals can be seen on National Geographic pouncing playfully on their mothers and pawing joyfully through foliage after insects, children also learn, explore, and heal through play. Through the repetitions of motor skills and behaviors such as in play-based behavior, brain activity is altered and the brain changes (Kolb, 2009). Truly comprehending this understanding of learning through experience and the undeniable power of play in learning, growth, and development changed everything for me about how I related with clients and families.
As I received further training in play therapy, I began feeling more comfortable taking known concepts, theories, and therapeutic interventions and making them tangible. For example, instead of expecting a young child to talk about her day or process through stressful and traumatic experiences verbally, I began to use story stones. These are tangible rocks with small pictures on them that children can use to show the linear progression of an occurrence and identify the changing emotions in the story they are sharing. These visuals allow children to explore and identify what they could have done differently to change the outcome of the story (for example, take a stone representing yelling and throwing things and replace with a stone representing taking a walk). These pictured stones also became a sorting game in which clients would sort the pictures based on emotions they elicit for them, thus identifying triggers and leaving opportunities to process unresolved trauma-related experiences and gain self-awareness and self-perceptions. Who knew some little grey stones could be such a powerful tool in any social worker’s office?
Pinwheels, Spheres, and Puppets
Deep breathing became an active and interactive experience, as I taught children to use pinwheels to notice their breath as it leaves their bodies. Children squealed with joy as they were able to notice the difference between short breaths and more extended, slow breaths on the pinwheel’s movement. I would “slow race” children by having each of us breathe slowly on a pinwheel and seeing whose pinwheel would spin for a longer amount of time to practice releasing breath more slowly and consciously.
I also have used an expanding sphere to illustrate deep breathing and using the whole lungs to breathe in (while expanding the sphere) and breathe out slowly (while condensing the sphere again at a slower rate). Adults enjoy breathing with the sphere as well! (See picture on the next page.)
Cognitive behavioral techniques became a fun and interactive “thinking X-ray machine” where the internal thoughts of puppets could be explored and changed to help the puppets feel happier and calmer, thus changing their behaviors.
As I continued with these tangible interventions, I began to realize they were not only effective with young children, but also with older children, teens, and even adults. During family sessions, parents would make remarks such as, “Wow, I never thought of deep breathing that way. That’s really cool,” or, “Can I also make a Play-Doh sculpture of what I think my anger looks like?” I have had parents and caregivers initially scoff at or question the idea of using play in therapy and then find themselves on the brink of tears in sessions as they witness and participate in social and emotional learning and healing in a whole new way.
There is actually brain science to back up why such tangible interventions are so powerful across the life span. First of all, tangible interventions that use more of the senses (such as touch and hearing, sight and smell, as opposed to just hearing) access more of the brain to process the information. This makes the experience more integrated in the brain, thus more effective and more likely to be remembered. Learning and engagement for children and adults happen most efficiently when the experience involves multiple senses (Steinberg, n.d.). So, asking a client to recall a positive memory to use this week as a coping skill makes more of an impact if you have the client also draw it (even better with scented markers) or act it out with puppets or in the sand tray. Sensory-based experiences target healing in lower levels of the brain and have even been described as the “primal language” used in therapy (Malchiodi, Crenshaw, Gaskill, & Perry, 2015).
Neuroscience is paving the way in social work, because neurons and connections in the brain can be studied. These connections represent our typical patterns of thinking, responding, and behaving and are hardwired from experiences in our lives. Neuroscience also shows that new neural connections can be made, despite existence of other less helpful pathways. When an individual experiences surprise or an unexpected occurrence, this hardwires into the brain much faster. New pathways are formed without as many repetitions, because there is a feedback loop involving the hippocampus—the brain’s “novelty detector” (Fenker & Schütze, 2008). So simply talking about and explaining deep breathing as a coping strategy is helpful, but when introducing some more surprising and sensory related stimuli to practice this skill, the skill is more likely to be retained in memory because of the novelty.
My first social work position out of graduate school may have been challenging, but it pushed me to seek new ways to reach clients, which has changed everything for me as a therapist and as a social worker. I have been both humbled and inspired by the resilience, growth, learning, and healing capacity of clients when given the tools to fully access what they need.
Tangible social work isn’t just child’s play. It’s neuroscience, and although it is not always easy, it is always worth it.
Fenker, D., & Schütze, H. (2008, December 17). Learning by surprise. Scientific American. Retrieved July 25, 2016, from http://www.scientificamerican.com/article/learning-by-surprise/
Kolb, B. (2009, December). Brain and behavioural plasticity in the developing brain: Neuroscience and public policy. Paediatrics and Child Health. 14(10), 651-652. doi:PMC2807801.
Malchiodi, C. A., Crenshaw, D. A., Gaskill, R. A., & Perry, B. D. (2015). Creative arts and play therapy for attachment problems. Guilford Press.
Steinberg, D. (n.d.). Developing and cultivating skills through sensory play. Retrieved July 22, 2016, from http://www.pbs.org/parents/child-development/sensory-play/developing-and-cultivating-skills-through-sensory-play/
Kristina Sargent, MSW, LISW-S, is a child and family therapist in Cincinnati, Ohio, and has specific interest in working with children who have experienced trauma. Kristina uses play and art based interventions and posts ideas and inspiration regularly to her blog at http://www.artofsocialwork.com.