8: Using Movement in Play Therapy
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 Body Keeps the Score can be found on Amazon by clicking on this link: https://www.amazon.com/Body-Keeps-Score-Healing-Trauma/dp/0143127748
Prologue
Have you thought about how to incorporate movement into your therapy work? That’s the theme of this episode.
Early in my counseling career, I knew that some kids really needed to be moving before we could do much talking therapy. I walked with them around playgrounds, created targets for throwing soft balls at (ones that made a splat sound were much more satisfying), and made it clear that I didn’t expect them to sit a chair the whole time. But, I had never even heard of a dance and movement therapist, and if I had, it would have been too far outside the box of what I thought therapy was supposed to be.
Boy, was I wrong.
Now, I believe that we hold trauma and pain in our bodies, and physical movement is an important tool for helping clients release it. Books like The Body Keeps the Score have made this idea more mainstream, but I know some therapists who use yoga, treadmills, and full-body work as part of the way they approach healing work. Some individuals self-medicate with fitness, just figuring out that running or kickboxing makes them feel better emotionally as well as physically. Dance and movement therapy is not part of my education, training or experience, but I have learned that somatic issues are often how clients “feel” things. Clients who express symptoms somatically, are showing you that they may respond well to techniques that include movement.
Disclaimer – Dance and Movement Therapy vs. Movement in Therapy
If you’ve been listening to other episodes this season, you already know that I am going to start with a disclaimer. Here in the United States, the American Dance Therapy Association is a professional organization that offers credentialing to be able to call yourself a Dance/Movement Therapist. You can find out more by going to adta.org. Without those credentials, you cannot claim it as your scope of practice, but you can use dance and movement techniques in your therapy work with your advanced degrees and training in a helping profession. So what I am talking about today is what I will call “Movement in Therapy.”
What Is Movement in Therapy?
Obviously, this any kind of physical movement. Usually, you are using some sort of large motor skills, so walking, shooting baskets, stretching, tossing a ball back and forth, or anything else that has the client – and maybe you, too – moving. It can include movements that are associated with sports like running, boxing, or martial arts. It might include movements that are helpful for relaxation, stretching or stress reduction. Or, it might be movements that boost body awareness, body image, or an ability to take up more space.
However, movement in therapy may also intentionally use stillness, too.
What Materials Are Needed?
At a minimum, you just need a body to move. You can incorporate movement without any special equipment. If you like to invite your clients to do big movements, you will need more space than a typical therapy office offers. This is probably a good time to remind you about the importance of a confidential space. If you take a client outside to walk, that outdoor space must be just as confidential as the space behind your closed office door, and you must ethically inform your client of possible limits to that confidentiality.
If you like to use specific kinds of movement, you may want sports equipment, ribbons, parachutes, resistance bands, yoga mats, or a weighted blanket. It’s handy to have various sized balls, too.
To Prompt or Not To Prompt?
What about prompts? Like other expressive arts, how much or little you prompt will be guided by your theory and your preferences. If you have a specific reason for incorporating movement, you will probably prompt the activity. Kids will likely use movement without prompting if they feel free to do so, but adults may not without a prompt, so your clients may determine how much you prompt, too. One prompt that I use a lot is just to notice the physical sensations in your body. I’m also watching to see if clients are fidgety or nervous in their movements. When I see a lot of that, I like to encourage them to move around.
Dance and Movement Across the Lifespan
Children are more prone to moving around, but adults are conditioned to stay seated and mostly still. I like to use age as a gauge for how long sitting is appropriate. That means that if I have 20-year olds, it’s best if they get to move somehow every 20 minutes and 5-year-olds need to be able to move every 5 minutes. That’s just a loose suggestion, but most people can concentrate and self-regulate easier when they can move, or if they are moving a lot, switch to stillness.
Children
With children, age is important to consider. Very young children will move a lot naturally, but they also need more rest. Both are important to consider when using movement. Many playrooms are equipped with toys that encourage movement, so if you already have a playroom, you probably already have a space that invites movement through typical playroom activities like dress up, moving cars around a carpet or play in a sand tray. What you might not have are the toys and materials that invite stillness. Many kids do or watch parents do yoga, so having a yoga mat might be something to include. Fish tanks with soothing bubbles might calm clients and invite stillness.
Adolescents
Adolescents are less prone to move around without a little encouragement. Most are used to being expected to stay seated in school, so it may seem like an office setting has similar rules. So, one way to include movement might be something like replacing a client chair with an exercise ball to sit on instead… or at least having the option. This might be a way to improve your own fitness, too! I think fidget toys are a must with adolescents, and this way of giving them something to do with their hands is adding movement. On the flip side, a weighted blanket (maybe even one that is scented), is comforting and calming. It might be helpful for reducing movement.
Young Adults
Anxiety is running rampant with young adults. If you see this population, you probably see a lot of anxiety. Adding movement is a great way to help get some of this out of the body physically. Adult coloring pages may help with this as they can keep their hands moving. In addition to fidget toys and an adult size exercise ball for a chair, you could use resistance bands for clients to tighten and release arm, shoulder, or leg muscles, especially in areas where the client feels tension. One strategy I have used is to alternate some office-appropriate movement with stillness. Move a little, close your eyes and notice what you hear. Move a little, pause and notice the color yellow.
Adults
Older adults may feel very awkward moving. Be aware of that. One thing that might help is some psychoeducation about movement in therapy and some transparency about why you are suggesting it. It could be very strange to be expected to sit on an exercise ball, or you may have a client with some physical or balance limitations that would make that a bad idea, so always have a comfortable chair available, too. Also, clients – especially those who have experienced trauma – may somatically feel things in their core more than their extremities. If a client has a need to protect that, then movements that challenge them to open their core area may be too vulnerable and create resistance. If a client is uncomfortable with movement, it might be best to try something else.
Safety
I want to get to the interview with our guest, but I want to leave you with a word about safety. If you are encouraging movement, there could be a risk of injury. First, don’t try to lead yoga, self-defense or other athletic moves without proper training. Second, while a good workout can be therapeutic, therapy is not the place for a workout. Finally, it’s probably a good idea to be prepared with a first aid kit just in case.
Interview with Dr. Jennifer Rubens
My guest today has many years of experience working with children, and she is going to share a movement technique with you called Marshmallow Catapult. Dr. Jennifer Rubens earned a Ph.D. in Educational Psychology specializing in Individual Differences, but is working towards an additional master’s degree in clinical mental health counseling. She is currently working as a counseling intern with Paris Goodyear-Brown at Nurture House working with children, and she is also interning at Lipscomb University’s Health Center, working with adults in integrated behavioral health. She uses Trust-Based Intervention and Trauma Play in her work. Before returning to school, she worked with children on the autism spectrum along with their families and support systems. In her work, Jennifer facilitates a lot of movement to help clients self-regulate and learn emotional literacy.
[The interview portion of this episode was not transcribed. To listen to the interview click the episode link at the top of the page.]
Research Summary
This season on the podcast, we’re diving into the expressive arts, which I’m personally really excited about. Sometimes I think our culture tends to over-value our left-brain logic and de-value our right-brain creativity. So, I want to spend this episode talking about what Dr. Dan Siegel termed “integration”, and how we help our clients have a more balanced brain using expressive arts. So, while today’s episode won’t focus on a specific research article, it will focus on unpacking some of the science that ultimately supports using expressive arts in the therapy room.
What Dan Siegel means by “integration” is both a horizontally integrated brain and a vertically integrated brain. In a horizontally integrated brain, left-brain logic can cooperate with right-brain emotion. In a vertically integrated brain, physically higher parts of the brain (the prefrontal cortex) cooperate well with the lower parts, like instinct, gut reactions, and survival.
In Dan’s book, The Whole Brain Child -- a must-read for therapists who work with children and parents -- he says, “in order to live balanced, meaningful, and creative lives full of connected relationships, it’s crucial that our two hemispheres work together.” He goes on to describe how important it is that we avoid living in an emotional flood (right-brain dominance) or an emotional desert (left-brain dominance).
And isn’t this what we see with our kids and our adult clients who have experienced trauma, big and little T, as well as grief and loss. Thanks to recent research, we know now that trauma is stored in the right brain in the form of sensory input and implicit memory. So, from a brain-based perspective, it makes total sense for our clients to retreat to the left-brain, to hide from and deny what is painful. On the flip side, they may be completely flooded by the images of a painful experience and to feel totally engulfed by their emotions, hence the term “emotional flood”. I tend to refer to this as dysregulation. So, part of the therapeutic process then becomes helping children and adults learn to regulate their brains, and we can do that using the expressive arts!
One way we can do this is through storytelling, and Dr. Dan Siegel and Dr. Tina Payne Bryson talk about this in-depth in the book. Storytelling is expressive in nature, and several different expressive mediums can be used, like sand tray, art, puppet play, and expressive writing, as pathways for stories to be told by the client and held by the therapist.
When we tell a story, the right brain is processing the emotions and memories related to the story, and the left brain is working to make sense of those emotions and memories. So, healing from hard things, whether it’s being bullied at school or a major loss or trauma, happens when the left side works with the right side when both parts of the brain begin working together and communicating with each other.
The expressive arts, especially in the context of storytelling, can also mitigate the fear that children may have of sharing a hard thing. They may not be ready to talk about it (which is a left-brain job), but they can show us in the sand tray or with an abstract painting (which is a right-brain job). In other words, art and play make the trauma content more approachable to children and adults and it allows the therapist to meet the client where they are.
Ultimately, being aware of this concept of integration helps us to know when and how we can use expressive arts to encourage connections between the right and left hemispheres of the brain. If you want to read more about Dr. Dan Siegel’s work, I encourage you to check out his website at www.drdansiegel.com
Conclusion
Movement in therapy makes a lot of sense. I didn’t talk much about incorporating dance because I don’t have experience in that area, but you could use full-length mirrors, balance, reaching and other dance materials and techniques in your work. You know what would best in your work setting.
Thank you to our Expressive Arts Technique guest, Jennifer Rubens.
Try this today: Get a small container and some toys for your clients to fidget with and see if it impacts your therapeutic work when they are holding them. Visit the American Dance Therapy Association’s web site to learn what the pros do and find one thing to test out in your practice.
