You're listening to the Play Therapy Podcast with Dr.

Brenna Hicks, your source for centered and focused play therapy coaching.

Hi, I'm Dr.

Brenna Hicks, The Kid Counselor.

This is the Play Therapy Podcast where you get a master class in child-centered play therapy and practical support and application for your work with children and their families.

In today's episode, I am answering a question from Liba in Pennsylvania.

And this is about a specific child with whom she's working, high levels of anxiety and diagnosis of ADHD.

And just some concerns about some different facets of that work.

So, thank you, Liba for the question.

I'm excited to dive into this.

Before I get there, I want to let you all know that the podcast meetup is taking place on October 11th in Houston.

Several blocks from the conference hotel.

So I would love to have you there.

I would love to meet you.

I would love to hug you.

I would love to hang out with you.

So if you are going to be able to make it, please let me know.

There will be a link in the show notes and you can RSVP for that.

I'm, that's one of my favorite things throughout the year is doing meetups, so I'm really looking forward to that.

Please try to get to Houston so that we can hang out.

All right, so let me read parts of Liba's email and then we will dive in together.

I have a kid who from the moment he arrived was questioning how the therapy works and why it will work for him, and he is 8.

Having high anxiety and intense ADHD, it makes a lot of sense that he wants information and to feel a level of control over the situation.

In the beginning, I empathized with him.

Hmm, this just doesn't make sense, which was not only helpful to him but incredibly infuriating.

To the point of throwing things at me, running out of the room constantly, hated that I would not directly answer questions, that I noticed his feelings or what he was doing, and essentially every part of the process.

With consistent limit setting, I'm able to navigate those behaviors, but a strong distaste for me and the therapeutic process as a whole emerged, and he's in a constant state of distress from the drop off, pleads with me to leave the entirety of the session.

My acceptance and being with attitudes are seen as unhelpful, especially due to his rejection of me.

I tried to make the space more comfortable for him by instructing his mom to bring with him a toy from home because in the previous session he screams that he hates all the toys here and wished that he had toys from home, but I got similar results after a particularly emotional session where he refused to leave the room and due to having a client afterwards, I could not utilize as much time and patience as I wanted, forcing me to provide him the choice of leaving on his own or with his father.

I realized I had to change something as he was begrudgingly being convinced to go with his dad.

The next session we met before his mom came back with us as a comfort measure, and I explained the therapy to him in child appropriate language that when you get to be by yourself and make your own decisions, a lot of time things get easier and kids feel less afraid.

And he agreed to give 4 times with the caveat that I would answer any questions he liked for the first or last 5 minutes of each session, and he could choose the timing of that.

That first session was game changing.

My hunch is probably due to his increased sense of control, and a smidge of therapeutic alliance was emerging.

The session afterwards, however, we went back to how things were were in the beginning.

He stated how this was dumb.

It doesn't work.

He isn't less afraid how much he hates me.

And when I would try to accept these feelings, he would scream at me to shut up and that he doesn't want me to say his thoughts or feelings.

Even when I tried more casual reflections that weren't using your feeling, such as it sucks, he would get so mad, so I respected his clear messaging for space and was present with him but silent.

He said at the end of the second session that he hates this so much and doesn't want to finish the 4 he agreed to that it wasn't a fair agreement and I can't make him.

These behaviors are in fact deeply connected to his presenting concerns, bringing him to therapy, but I'm left wondering if CCPT is a good fit for this particular client or if I'm missing or doing something wrong.

OK, wow, Liba, that is quite a client.

And we've all had them, we've all been there, so we, we empathize for sure.

All right.

So there's a lot to unpack here and I'm just going to kind of go in order of arrival.

So this isn't really prioritized.

I'm just going to share thoughts reading through that email.

First and foremost, we know that kids with high levels of anxiety, their way of handling the anxiety is taking control over as much as they can control.

So you were spot on with your perspective that it made sense because he wanted a level of control.

Absolutely.

We also know that highly anxious kids are likely to have really high levels of resistance.

So we have comorbidity of need for control in highly anxious kids as well as very high levels and intense levels of resistance.

With high anxiety, so you're seeing both this is normal this is expected this is something that we can look at and recognize immediately as a control issue.

So at the very least, hopefully that will alleviate some of the concerns because this is a standard part of working with a highly anxious child.

So when he comes in, And gets frustrated.

Then starts behaving to show you how desperate he feels.

So he is throwing things at you, running out of the room, all of that.

That's his pushback.

He feels overwhelmed.

He feels out of control internally, and children will show outwardly how they're feeling inwardly.

So he wants you to understand how awful he feels, and he's going to try to grasp at any measure that he can, which he has control over his behavior and it's not a cognitive control.

He's just aware that he feels really badly and so he's going to behave how he chooses.

That's one of the five things over which kids have control.

And I also suspect since this is very early on in the process, he doesn't trust you, he doesn't have rapport or relationship with you yet.

You're essentially a stranger to him and what he has proven again and again because this is a standard part of anxious children.

They learn if I escalate, if I ramp up, if I make demands, if I get out of control, if I get this to a point where no one else can take it, I get my way.

This is the way that anxious children learn to function.

They condition everyone around them to do what they want to avoid the meltdown, to avoid the tantrum, to avoid the throwing, to avoid the running, so everyone kowtows to anxious children, everyone concedes around anxious children.

Everyone gives in to anxious children.

Everyone in an anxious child's world essentially learns to walk around on eggshells.

And when that is taking place, then obviously the child is conditioned.

Well, if this little bit of escalation didn't work, I have to ramp it up.

Oh, that didn't work, I have to ramp it up again.

And everything continues to spiral.

So in people's best intentions of I just wanna keep them calm.

I just wanna keep them happy.

I don't want them to feel really anxious and overwhelmed, so I'll do whatever.

It actually begets the cycle where things get worse and worse and worse, and the child never actually confronts their anxiety, which means they just learn to avoid it, which also resets the spiral.

So it's a really unfortunate pattern.

But again, very normal, Liba.

I'm, I'm hoping that you're going to recognize as we go through this, everything you're describing is expected and a part of the process.

So when you let his mom have him bring a toy.

That is a helpful realization.

He was saying he didn't like the toys and he wished that he could have brought something from home.

But let me be real clear.

And I've actually talked about this on coaching calls quite a bit.

It is never about what the child is insisting that it's about.

So when he's screaming that he hates your toys and he wishes he had a toy from home, that's not actually what's going on for him.

He doesn't actually hate your toys.

He doesn't actually wish that he had a toy from home.

That's a verbal representation of I'm just trying to get myself out of this mess.

And so when you have that pattern of behavior, we can't get caught up in what the child is saying we have to recognize there's something deeper going on and therefore, when he brought the toy the next time, it didn't solve the problem, of course it didn't.

When you conceded and said, OK, I'll ask questions for you for the first or the last 5 minutes, that didn't solve the problem either.

When mom came back with him, that didn't solve the problem either.

You can see his demands and what he's insisting.

They're just grasps at ways to solve the high level of worry and fear and anxiety that are swirling around inside of him.

That's never the solution.

For my coaching folks, it's never about the two.

You all know what I mean.

So I think it's really important, Liba to recognize when you said he can bring a toy from home, that was your attempt at accommodating his needs, but his need was not to have a toy from home.

His need was to avoid how uncomfortable and awkward it feels to go and have to face your junk.

So that is what kind of unfolded there.

And then when you had that session where everything seemed calmer, so you said that first session was game changing.

He had an increased sense of control and a smidge of Therapeutic alliance was emerging.

Of course you're only in your first few sessions, so the more sessions you have, the more relationship is built.

That absolutely would be a contributing factor, but you also.

Talk to him about how many times he would come.

That was concrete.

So he chose to come 4 more times that gave him a sense of knowledge of what's to come and what to expect.

You said you would ask, are you sorry, you would answer questions for the first or the last 5 minutes.

He felt that he had sway over the session, but it was short lived.

It only addressed something temporarily.

Why?

Because the anxiety is still there, because the need for control is still there, because the paralyzing fear is still there, because the junk he needs to work through is still there, resistance is still rearing its ugly head, and so on and so on.

So the fact that you had that temporary respite.

That's what always happens.

People give in, they get this little bit of relief, and then they're right back into the spiral again, which is what he's showing again and again.

So when you said he would scream at you to shut up, we all have been there, and, and I know none of y'all can see each other, but raise your hand if you've had a child tell you to shut up in a session.

I know all of you just raised your hand because this is the nature of CCPT.

So we are told to shut up, we are told to not talk.

We are told to be quiet and don't say one more thing to me.

Don't tell me how I feel.

Don't tell me what I'm doing, don't tell me what I'm thinking.

All right, it's a control grab.

It's for power.

They need to feel that they get to do something other than be at the mercy of the environment.

That is a very common process when you said that you respected his message for space and you were present but silent.

I've talked about this a lot.

We cannot do our job.

Unless we speak.

Yes, the relationship supersedes everything, so there is power in just being with a child and I don't mean to be with attitudes.

I mean just being with, being present, being engaged, being a part of the session, of course, there's value in that and the relationship is still there.

But the way that a child understands what's happening, the way that a child processes, the way that a child experiences, what they're working through.

is in part because of our therapeutic engagement verbally.

That's why we have reflective responses.

That's why we have pillars.

That's why we have techniques because it facilitates self-actualization.

We can't do our jobs if we say nothing.

And therefore, even when a child tells us to shut up, even when a child tells us not to talk, we have to slow down the pace, we have to slow down the frequency, we have to slow down the tone, so we might whisper and we may go 30 seconds before we say something, and we talk slower and gentler because the child does not want us to talk.

But we can't say nothing.

Because then we're not engaging in a therapeutic way with dialogue that a child needs.

So a lot of us struggle with that because I was told not to talk.

Yes, but kids also tell us to handcuff ourselves to something and stay like that for 100,000 years.

Kids also tell us that you are the stupidest human on this planet and I never wanna see you again.

We don't believe that to be true either.

So we have to recognize it's a power and control grab.

And when kids tell you to stop talking and shut up, and if you say one more thing to me, I'm going too.

Our role is to respond.

We adjust our responses, but we respond.

And then of course, it does not surprise me at all that he says he hates this so much and he does not want to finish the 4 that he agreed to.

Why?

Because he agreed to the 4 when he felt that he could handle it and he's realizing that he absolutely can't handle it.

So now he's backpedaling, but the beauty of CCPT and the beauty of the process is that he chose to do 4 more.

You have set appointments and you're going to sit in the pocket of his discomfort and you're going to sit in the emotion and the experience and the resistance and the power and control and the anger and all of this stuff with him.

And he's going to continue to come.

And parents need to reinforce that, you need to reinforce that.

You know that when you get here, you get to decide what happens.

I'm gonna see you next week on Tuesday at 4.

And you get to decide what happens.

Meaning the appointment is non-negotiable, but whether you choose to play or whether you choose to talk, whether you choose to come into the playroom, whether you choose to say you hate me for 50 minutes straight, whatever happens once he's there, that is completely up to him under his control, but coming to the session is a standard part of the week.

So in answer to your final question.

They're connected his behaviors are connected to his presenting concerns.

Of course they are, because kids know what they need to work on and they can't avoid it.

So everything that he is struggling with is coming up.

That's why it's upheaving him.

That's why it is jerking the rug out from underneath him.

And then you're left wondering if CCPT is a fit for him.

100% yes.

Any other model, any other theoretical modality is going to force him to do stuff.

You need to talk to me, you need to do a worksheet, you need to do an activity.

We need to do deep breathing.

We're going to do the anger monster sheet.

We're going to, whatever.

And the child is going to be forced into doing something.

Which is going to create more resistance and more anxiety and more overwhelm.

And being given the time, the tools, and the opportunity within the context of CCPT, he will actually address the anxiety at its root.

It won't be superficial, it won't be high level.

It won't be band-aid on the gaping wound.

He will actually conquer the unmanageable levels of anxiety that he's experiencing as he goes through this process with you.

So yes, 100% it's appropriate.

Stay the course and you are not missing or doing something wrong.

Stay adherent to the model.

Continue to engage therapeutically.

Respect him where he is, unconditionally accept him.

Set limits when necessary.

Use the pillars, use the reflective responses.

Be with him.

And it will sort itself out.

Trust the process.

Trust the process always.

Trust him, trust yourself, trust the model, trust the process.

I love y'all.

We'll talk again soon.

Bye.

Thank you for listening to the Play Therapy Podcast with Dr.

Brenna Hicks.

For more episodes and resources, please go to www.playtherapypodcast.com.