21: Power and Control - Perfectionism and Anxiety
Note: Play Therapy Across the Lifespan is created to be heard. If you are able, we strongly encourage you to listen to the audio so that you are able to appreciate the emotion and emphasis that cannot be captured by text alone. Transcripts may contain errors and differ slightly from the audio. Please check the corresponding audio before quoting it in print.
Resources and Links
The Boy Who Was Raised as a Dog on Amazon:
https://www.amazon.com/Boy-Who-Raised-Psychiatrists-Notebook
Prologue
This week I want to talk about themes in the category of power and control. This will be a two-part podcast. If you haven’t listened to the last one on safety, security, and protection, that might be a good one to go back and listen to, and next time we’ll continue themes related to power and control.
First, let me say that we all have all of these needs, the four categories I call core needs. Safety and security was the first core need, and empowerment and control is the second. They become problematic when a person experiences or fears the need not being met. Now, I call the need empowerment because the words power and control have such negative connotations, but this is really just about having the ability to order and control things to take care of yourself. In trying to meet the need, a person may become manipulative, controlling, or overbearing, but the need itself is not negative. We all want agency in our lives, to be able to make decisions and determine things about the future. But, as we know, that doesn’t always happen. People, things, a deity, and fate remind us that we don’t always have power or control over things.
The themes you may see with your clients’ play may be around trying to regain some sort of power or ability to control things or the reverse. They may play out being overpowered (physically, mentally, or emotionally) or being unable to assert any autonomy. Two specific themes that I want to talk about here are perfectionism and anxiety, but remember here that I am talking about them as a way to meet needs for empowerment and control. You might also see these to meet other core needs like safety or inner value, and in those cases, they will look different. So, consider the “why” behind the behavior, which need the client is trying to meet.
Perfectionism is a common way to try to feel some empowerment and some control over a situation. Sorting play, arranging things in perfect symmetry, trying to be the best, fretting when things aren’t just so, all give the client a way to assert some control over circumstances. Maybe he can’t be with the loved parent who had their rights terminated, but maybe if he keeps his room perfectly clean or makes very good grades, the parent will come back. Maybe she can’t stop her parents from getting a divorce, but she can learn to control hunger signals by restricting and overcome uncomfortable emotional signals, too. Both of these give the client some version of empowerment and control when it feels like they don’t have any. Some is better than none, even if it is through efforts that clinicians call “maladaptive.”
Anxiety is another common one. This one is driven by fears of not having empowerment and control. What if I study hard for the test and still fail? What if I try to make them stop, but I am still bullied? What if no one will be my friend? These all seem out of the client’s control… and the feared results are bad. Many clients have experiences where the bad stuff actually happened, so this isn’t just imagined fears. So, the anxiety arises from an inability to meet the need, but it also serves in a backhanded way to attempt to meet the need. Maybe by considering all the dreaded possibilities, I can prepare for them so they aren’t so bad if they actually happen. Maybe when my body physically feels the symptoms of anxiety, I become familiar with them so that when I really am in a scary situation, I am not caught off guard. Do you see how there is a logic behind how anxiety may actually help to meet the need for empowerment and control?
Armed with this knowledge, how do you help your clients? I have some thoughts on that, too, but first, let’s hear another book review from Rachel.
Rachel’s Book Review
Today I’m going to be discussing a book that I think should be a required reading for any and all therapists called, The Boy Who Was Raised as a Dog: And Other Stories From a Child’s Psychiatrist’s Notebook — What Traumatized Children Can Teach Us About Loss, Love, and Healing, by Dr. Bruce Perry and Maia Szalavitz. Like The Deepest Well, the book I discussed in our previous episode, the focus of this book is trauma, maltreated children, ACEs, and their impact on the brain and development. Perry and Szalavitz structure this book in a way that sequences clinical vignettes, weaving together science and story in a balanced way. Towards the end of the book, Perry discusses the Neurosequencial Model of Therapeutics, Perry’s clinical model that is now used by thousands of mental health professionals.
What I appreciated most and what was also really difficult and distressing at times was how transparent and direct this book is about the realities of trauma. I cried, I gasped, I sat speechless in disbelief in response to some of the horrific stories and details shared. Eventually though, I felt hopeful. Hopeful that we, child and adult therapists alike, are becoming more and more equipped to help bring about lasting change and deep healing for our clients.
It’s hard for me to share my favorite part of this book. When I flipped back through the pages while planning for today’s episode, I saw a plethora of astricts, highlights, underlines, and notes. I thought about sharing one of the case vignettes but decided that I wanted you to experience them as a reader first. Eventually, I decided that for today’s episode I’d share some of the important ideas that Perry and Szalavitz taught me.
Something I learned from this book is the importance of giving children patterned, repetitive experiences appropriate to their developmental needs, specifically needs that reflect the age at which they were traumatized. Perry explains why his model is called “neurosequencial” and shares his thoughts about targeting therapies to help the affected brain areas in the order in which they were affected by neglect and trauma. Essentially what he is advocating is a bottom-up approach to trauma treatment. For several of the kids he describes in the book, their trauma occurred before the age of two or three. According to Perry, therapies need to target the primal areas of the brain first. In the book, he describes several case examples of how this might look, such as learning to tolerate sustained physical touch and synchronized bodily rhythms.
What I love about Perry’s approach to treating trauma is how it is both neuroscience-informed and incredibly relational. Perry understands that it is the therapeutic relationship that ultimately heals a traumatized child. I’ll leave you today with one of my favorite quotes from the book. “The more healthy relationships a child has, the more likely he will be to recover from trauma and thrive. Relationships are the agents of change and the most powerful therapy is human love.”
Conclusion
I am really loving that book review segment. I hope you are, too.
Okay, I promised to share my thoughts on how you help your clients once you have identified that they have a core need for empowerment and control. The themes you see may be power, control, perfectionism, anxiety, or others that we’ll talk about next week, but underneath that is a need for order and agency, a need to assert their wills, a need for empowerment, and a need for control.
In child-centered play therapy, I believe that the client has what they need to do the work they need to do. I’d argue that what we see are (sometimes faulty) attempts to do that. How brilliant is the client who creates order to combat a chaotic environment? How do even little ones figure that out? What we do is create a healthier context through the therapeutic relationship so the client makes attempts from a healthier place. What does that mean?
Well, we convey empathy instead of judgment. We are genuine, and let our clients be genuine, too. We consistently express unconditional positive regard, especially when they are disempowered and life is out of control. They still have worth and value, and those give us glimpses into how remarkable our clients are.
My students hear me say, “Reflect, reflect, reflect” all the time. I think it is probably the most important skill we can learn, and it is often more impactful than questioning. If you know that a client is expressing themes around empowerment and control, then you reflect that back to the client. “It’s out of your control when the judge determines your visitation schedule without even asking you what you want. The judge has power and you don’t.” Or, “That’s better. It’s nice to have all the blue blocks together and all the red blocks together. You decided that.” Doesn’t that sound empowering? It’s not really about the blocks at all. But you already knew that. In play therapy, the toys are just tools to express what is really happening. Once you recognize what your client is really showing you, then you can reflect that back, build awareness, and your client will discover better ways to meet their need, in healthier ways.
It’s not just reflection. Good reflections truly are the best way to help your clients do their work. As much as I want to encourage my clients that they can do it, rally them to confront bullies, and try to unlock their inner superhero to fight evil, well, those strategies don’t help them change from the inside out. Instead, when I verbally acknowledge those hard things, sit with them in the stuck places, and identify a need that isn’t being met, that’s when clients heal. There’s a reason why I end every podcast with, “Go play, create, and heal.”
