People often ask, “Will reading children’s books on special concerns, like anxiety, depression or mental health issues help my child?” The answer according to research is, yes! (Marrs, R.W., 1995; Dimova, 2007, Petris & Dimova, 2008 and Oelofsen, I., & Grobler, H., 2013)

Reading books like Healing Feelings: A healing story for children coping with a grownup’s mental illness to a child that lives with and/or interacts regularly with grownup who is managing a mental illness can benefit from the practice of bibliotherapy.

Bibliotherapy is the process of experiencing the written word such as books, poetry, and other written works by reading and exploring a book with my child! Bibliotherapy includes interacting with the written media with the purpose of delving into the concepts in order to increase emotional awareness, healing and psycho-education.  One of the goals of bibliotherapy is to provide insight for a child about the situation or special issue that the child is experiencing.

For a child, the type of bibliotherapy most often utilized is called Interactive Bibliotherapy in which a parent, foster parent, caregiver, therapist, counselor, psychologist, social worker, teacher and/or other person facilitates, not just in simply reading the story, but interacts with the child about the story.

The facilitator may draw attention to the feelings, connections, and/or situations in the story. The parent or counselor might wonder aloud, “Ouch, I might feel hurt if that were happening in my family.”  Another caregiver might say, “Point to the place on my body where you feel the worried feeling?” Some children will simply listen, other children may like to play along by naming feelings, finding and naming body sensations, or mimicking the voices of the characters. Since play is the language of children bibliotherapy can flow into playing. Some children like to imagine “what if” scenarios about the main characters. Others write or tell their own stories. While others enjoy creating a story from the book or poem into interactive play by either choosing to act out the story in a tray of sand with miniature figures or by acting out drama in live role play with costumes, hats and props. They may want to act out a “feeling” of a character or be a particular “character” and play out the story.

Children integrate emotions by expressing their stories through play. According to Dan Siegel & Tina Bryson (2011) the ability for a child to express their stories allows their brains to integrate the emotions and experiences. This enhances a child’s ability to gain a sense of mastery over experiences that trouble them and allow the child to have the opportunity to make sense of what is happens in their world. This can reduce stress and anxiety for children.

How can the stories like Healing Feelings: A healing story for children coping with a grownup’s mental illness help children? According to the National Institutes on Health, in 2015 there were an estimated 9.8 million adults aged 18 or older in the United States with severe mental illness.  A serious mental illness substantially interferes with or limits one or more major life activities. This may include depression, alcohol or drug use, bipolar disorder, schizophrenia, anxiety or other mental health issues.

Research studies over the years have indicated that bibliotherapy, especially that addressing children’s feelings is especially useful with issues of anxiety, which can be a common symptom with children coping with parent/caregiver with a diagnosis of mental illness. Children may show generalized anxiety or extreme worry about their parent or caregiver. Pretis and Dimvoa, (2008) recommend, in order to build resiliency in children whose parents suffer from a mental illness that “fostering an attachment to a healthy adult – including professionals in the social field – and providing information about the disorder are regarded as two important preventive factors” for children. Both of which can be achieved in the process of interactive bibliotherapy.

Attachment to a caregiver is critical in building a sense of trust and security base in all children. Pretis and Dimvoa** stated “age-appropriate information for children explaining the behavior and emotions shown towards them by their parents is regarded as one of the most challenging, but also most important factors in safeguarding child and adolescent mental health.” The message of Healing Feelings: A healing story for children coping with a grownup’s mental illness is hope for healing. The message is that mental illness can be treated and people do get better. Children often feel responsible for the emotions and difficulties with the grownups and families in their lives. The purpose of this story is to help children know that they are not at fault for adult’s emotions and their caregivers and/or family member has an opportunity for healing with help and time.

I tried to find a book to help me explain to my children that my own depression was not their fault. I also wanted to communicate to them that seeking help from a professional is healthy, even if it was taking time for me to feel better. I wanted my children to know I would not give up on getting better, and that even with my sadness, I loved them deeply.

It was my own experience of debilitating post-partum depression that impacted my family, which inspired me to write Healing Feeling: A healing story for children coping with a grownup’s mental illness.

My hope is that the story of my journey to help my own children heal and grow with interactive bibliotherapy, will help other children experience hope and healing. My desire is that my book also inspires caregiver’s to use these types of stories with interactive bibliotherapy to help other children. The tools found in bibliotherapy are powerful and helpful for children’s understanding of a grownup’s mental illness.

Bullying

An age-old trauma for school-age children in hallways and cafeterias, bullying continues its reign of terror. The forms and incidences of bullying, which include cruelty, exclusion, and rumormongering, have grown with the inclusion of cyberbullying now in the mix. According to the research by Hinduja & Patchin, (2018), students between the ages of 12 to 17 who were either bullied at school or online reported significantly more suicidal thoughts. The youth who experienced both school bullying and online bullying reported more suicidal thoughts and attempts. Lastly, the students who were bullied online in a way that impacted them at school suffered an increased risk of both suicidal thinking and attempts.

Understanding the effects of bullying is critical; it’s particularly insidious in childhood because it disrupts brain development, impacting self-regulation and the ability to build healthy relationships in adulthood. According to the National Academy of Science (2018) summary, “regardless of the mechanism, being bullied seems to have an impact on mental health functioning during adulthood.” The study also noted that:

…the effects of being bullied on the brain are not yet fully understood, there are changes in the stress response systems and in the brain that are associated with increased risk of mental health problems, cognitive function, self-regulation, and other physical problems (Conclusion 4.3). (para. 19)

Traumatic experience, like those noted in Acute Childhood Experience Scores  (ACE Study),  links childhood traumatic events to later serious health problems and to emotional and social difficulties such as depression and suicidal behaviors. Trauma in childhood impacts self-regulation and connection formation throughout a child’s life span changing the brain and the body.

Mitigating the Effects of Bullying

Multimodal Play Therapy Intervention incorporates Integrated Play Therapy Theory, Neuro-Sequential Model of Therapeutics by Dr. Bruce Perry, and moderate exposure training via experiential play therapy techniques such as down-regulation training with intervention including meditation, drawing, sandtray, and drama play. Multimodal Play Therapy Intervention assists trauma survivors to down regulate the stress system with mindfulness practices. Drawing desensitizes via moderate-to-prolonged exposure training and drama play leads to discovering and developing ways to move forward in connection with body movement. Throughout the process of the multimodal approach, these interventions assist in increasing the window of tolerance for traumatized clients and provide an opportunity for their brains to reintegrate trauma from a bottom up developmental neuro-sequential approach through the experiential play and expressive modalities.  (Part 1 of 3)

• References at the end of Part #3

The purpose of this article is to explore Technology Integrated Multimodal Play Therapy. All the steps can be integrated with technology in order to facilitate a client’s experience as a modality for change in the clinical setting.

Introduction to Technology Integrated Multimodal Play Therapy

Share with the client that over the next fmy to ten sessions the client will process their bullying trauma with the Multimodal Play Therapy Intervention. It involves the use of three different types of technology to allow a client to interact with the moderate-to-prolonged exposure to their choice of a bullying incident at their pace. They have the option to stop at anytime or to switch to the none technology option.

A Stepped Approach: Overview of Multimodal Play Therapy Intervention

1. Safety and downregulating with mediation/relaxation.
2. Drawing a scene from their choice of a bullying incident.
3. Creating a Virtual Sandtray®© of the bullying incident (iPad or iPhone).
4. Creating a drama play of the bullying incident with the Thera-Tool™ Figure or large toys.

• Each session includes the option for the downregulation as needed and includes witnessing, supporting and processing by the clinician.

Step I   Choose Bullying Incident

Have client choose a bullying incident that has been troubling them. If there are more than one, pick the first incident or the one that has been the most difficult for the client.

Step II Create Safety and Down Regulate

Introduce MUSE™ meditation application to assist the client with self-regulation.

The MUSE system is a medical grade EEG device that allows the client to listen to mindful mediation sounds and to simultaneously, on their phone app, track their ability to downregulate themselves and/or meditate. The objective is to slow their brain waves into a relaxed state. The client places the MUSE headband across their forehead and behind their ears. MUSE syncs up with their phone app and the session begins. The client can choose which sounds appeal to them, from ocean, forest etc.

The more they relax their brain and settle into a meditative state the quieter the sound of the storm and the more the client will hear little chirping birds fly by. The client and therapist can decide on the amount of time to try the MUSE application from as little as three minutes to more depending on the amount of time that suits a client’s need to downregulate. The MUSE app allows the client to see their progress in their ability to downregulate themselves and to see their progress. MUSE provides biofeedback for clients to see the progress they can make in self-regulation.

Step III Draw it Out

Invite my client to draw the bullying incident on the Computer/tablet or phone.

Witness as my client draws and invite them to share their story. It is important not to name or guess at the client’s creation. Let the client lead you and express what they have created if they so choose. They may choose to lend voice to a figure they have drawn or remain silent. As a clinician, remain open and supportive but refrain from interpretation. Rather be open to their interpretation if they offer one. Explore their emotional state and expressions as they offer them.

You are processing their bullying experience and you may offer the MUSE for downregulating as needed.

Clients may choose to draw one picture or over one to two sessions draw a few scenes that reflect their bullying experience. For the purpose of this modality you will have them choose one of the incidents they experienced to use throughout the rest of the process.

A clinician will need a Windows /Mac/ iPad /iPhone or Android to provide a drawing surface. A free drawing app like MediBang Paint will do a great job. A larger surface is preferable. Nothing complicated unless you are planning on doing more Art therapy-type interventions. A drawing pen is very helpful, which can be purchased separately depending on the device you own. Some will allow fingers as a pen, or special tip on a traditional pen can work well with some programs.

Step IV: Virtual Sandtray®© Creation and Processing

Invite my client to re-create the bullying incident they have chosen from drawing session(s) in the Virtual Sandtray. Choosing figures and other elements they wish to create the scene they are thinking about. A clinician should expect a change from what the client may have drawn. Metaphor often enters here but also may not show up, it really depends on the client.

Witness as my client works in the Virtual Sandtray and invite them to share their story. As in the drawing sessions, it is important not to name or guess at the client’s creation. Let the client lead you and express what they have created in the Virtual Sandtray if they so choose. They may choose to lend voice to a figure they have placed in the Virtual Sandtray or remain silent. As a clinician, remain open and supportive but refrain from interpretation. Rather be open to their interpretation if they offer one. Explore their emotional state and expressions as they offer them. You can ask “What is the title for my Virtual Sandtray?” and/or “What is the moral of my Virtual Sandtray?” or “What is my Virtual Sandtray trying to show others?”  

Clients may choose to create one Virtual Sandtray over one to two sessions and/or create a few Virtual Sandtrays that reflect their bullying experience(s).

Step V: Play It Out

Invite my client to re-create the bullying incident they have chosen from tablet drawing(s) or the Virtual Sandtray session(s) and dramatize it into live form dramatic play. For other characters, the client can utilize the Thera-Tool™ Figure as well as assign a role to the clinician. Large stuffed animals, puppets or inflatable animals can also be used as props if needed. Material provides an inexpensive way for the client to dress up and provide dress up for their characters. I recommend a basket of material 1½- 2-yard pieces in red, black, royal blue, green, pink and brown and two shear materials. I recommend various sizes of 2’wide to 1½ yard strips for tying material around themselves or the characters. The material serves as capes, covers, dresses and drapes for the client and the characters in their drama play. The ties also become several props, from blind folds to masks to various other props depending on the client’s imagination.

Leslie Baker, MFT, NCC, RPT-S: Licensed since 1991, Leslie serves couples, families, women, men and youth who are dealing with challenges in connecting to themselves, others and to their lives. Her specialties include: depression, anxiety, trauma, grief, loss and parenting issues; and she assists couples, individuals and families facing all types of life’s transitions and challenges. She provide safe and supportive, compassionate, results-oriented sessions to help reduce symptoms, increase resilience and options and facilitate well-being and happiness. https://gottmanreferralnetwork.com/therapists/leslie-baker

Medibang paint: https://medibangpaint.com/en/

Virtual Sandtray: http://www.sandtrayplay.com

Thera-tool: https://www.trinaswerdlow.com/thera-tool-figure/