Wednesday, August 31, 2011

Using Play in Adult "Talk" Therapy

Play therapists are quite ingenious. Because they work with children, they don't operate on the assumption that their clients can talk about their inner experience, so they've invented a wide range of interventions to figure out what's wrong and help make it better without the use of metacognition.

Those of us who work with adults know, however, that age does not guarantee that our clients can engage in metacognition or talk about their inner experience, either. Whether we think difficulties with these tasks occur because the client hasn't learned the necessary skills, has symptoms that interfere with abstract thought, or has defense mechanisms keeping threatening material out of awareness, we've likely all experienced impasses in treatment because of it.

When we reach such an impass, perhaps we should take a page out of the (metaphorical or literal) play therapy manual and exercise some creativity.

For example, the idea of cognitive distortions can be hard for some of my clients to understand - they get wrapped up in the idea that thoughts are facts, and must be believed. It helps a little for them to see the printed out list of common distortions - which suggests other people have similar kinds of distorted thoughts, too. But that only helps a little.

What helps more is introducing the idea of cognitive distortions using a fictional character. The same way children are more comfortable revealing their true thoughts and feelings when they can attribute them to a stuffed animal or puppet, adults will much more readily recognize how a character from television or fiction is thinking erroneously about something.

One of my favorite ways to start this discussion is using alternative fairy tales - versions of familiar children's stories that have been rewritten from the perspective of the "bad guy." The most famous alternative fairy tale is the book and Broadway production "Wicked," which tells the story of "The Wizard of Oz" with the Wicked Witch of the West as the protagonist. However, since "Wicked" is too long to be useful in a therapy context, I use The True Story of the Three Little Pigs

Do you use any forms of play, imagination, or creativity in your work? How do adults seem to respond?

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