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/