Trauma-Informed Adlerian Play Therapy
by Mason Greenwood & Kristen E. Eldredge
Counselors who work from a trauma-informed philosophy strive to incorporate principles of safety, trustworthiness, choice, empowerment, collaboration, and awareness of cultural, historical, and gender influences into their work (Substance Abuse and Mental Health Services Association [SAMHSA], 2014). These core principles align with humanistic counseling philosophies that seek to honor the client's individuality, experience, choices, and the power of the relationship between client and counselor (Scholl et al., 2014). For counselors who work with children who have experienced trauma, adopting a play therapy modality can integrate the elements of humanism and trauma-informed care in a manner that corresponds with the child's language, play.
A child's natural means of communication is through play (Landreth, 2012). Thus a counselor can gather a lot about a child's experience from their play. Commonly, a child in play therapy may script or play out their traumatic experiences even if the client did not come to counseling services because of their trauma. Therefore, counselors who specialize in working with children should work from a trauma-informed foundation, extending this foundation to the specific play therapy modality. Additionally, a Play Therapist must consider several different factors when working with trauma victims. Some of these factors include but are not limited to the child's development stage, the nature of the traumatic event, the child's support systems, and the child's awareness concerning the impact of trauma or their trauma reactions. Adlerian Play Therapy is a model of play therapy that integrates elements of play therapy along with the philosophies and assumptions of trauma-informed counseling with the underpinnings of humanistic counseling.
Adlerian Play Therapy
Adlerian Play Therapy is based on the belief that people have feelings of inferiority, social embeddedness, human creativity, self-determination, purposeful behavior, and subjective reality (Kottman & Ashby, 2015). From these factors, Kottman and Meany-Walen (2016) developed four stages to Adlerian Play Therapy: (a) building the relationship, (b) exploring the client's lifestyle, (c) helping clients with gaining insight, and (d) reorientation or reeducation. These stages are not always linear, and each one of these stages can be flexibly utilized. These stages are based on where the child is in the therapy process; for example, the child could be in the 3rd stage, and then a stressor or event happens in the child's life, causing damage to the therapeutic rapport. The counselor must then attempt to rebuild that rapport before proceeding to the other stages.
Above all else, Adlerian Play therapy is adaptive in the sense that it is not just a directive approach, like Gestalt Play Therapy, but also not only non-directive, like Child-Centered Play Therapy (Evans, 2021). It is also important to note that Adlerian Play Therapy is mostly non-directive but can use directive techniques depending on the client's needs (Evans, 2021). Adlerian play therapy's versatility and flexibility are crucial components when working with children who have experienced trauma.
Core Assumptions of Trauma-Informed Counseling in Adlerian Play Therapy
There are four core assumptions in a trauma-informed counseling approach. First is the Realization of trauma, meaning that counselors have a fundamental knowledge base of trauma and how it impacts those who experience it from an individual, familiar, and systemic level (SAMHSA, 2014). This assumption aligns with the first stage of Adlerian Play Therapy, Building the Relationship (Kottman & Meany-Walen, 2016). A trauma-informed play therapist needs to understand how a child's experience with trauma will impact the child's ability to build a relationship with the counselor.
The second core assumption in trauma-informed counseling is Recognition. The counselor should recognize manifestations of traumatic symptoms even as these expressions are influenced by age, culture, gender identity, and specific settings of service delivery (SAMHSA, 2014). For Adlerian play therapists, the second stage of Exploring the Client's Lifestyle facilitates this recognition (Kottman & Meany-Walen, 2016). Adlerian Play Therapists expressly understand how the influence of the child's developmental stage, familial, and environmental factors impact the expression of traumatic stress. For example, if a child's house recently burned down and they had experienced the panic of that moment, the child might reenact that traumatic event. Traumatic stressors make themselves apparent in repetitive play. A child may act out a violent scene or experience repeatedly in sessions. These types of play signify that the child is attempting to process the experience or show the counselor what they have experienced (Kottman & Walen, 2016).
The third core assumption in trauma-informed counseling is Responding, meaning that the counselor, agency, and overarching organization apply the fundamental principles of trauma-informed care (SAMHSA, 2014). In the case of play therapy, this means that every member of the practice, from the play therapist to the practice manager, uphold the tenets of trauma-informed care. Therapists should also become trained in evidence-based modalities that can effectively address the elements of trauma in their client's cases.
One of the considerations for working with children who have experienced trauma is finding appropriate interventions for that child, aligning with Adlerian Play Therapy's third stage of Helping the Client to Gain Insight(Kottman & Meany-Walen, 2016). The actual playroom is a key element of the interventions in play therapy. The playroom provides the tools of communication (such as toys and expressive materials) that allow for the child's expression. An essential item in the playroom is a sand tray with various figures or objects frequently connected to traumatic experiences and responses (e.g., death-related figures, authority figures like police officers, parental figures). Expressive materials such as egg cartons, bop bags, popsicle sticks, bubble wrap, and art supplies also help the child communicate their emotions related to the trauma through creativity.
Additionally, the therapist must utilize various techniques within the playroom setting to help the child process. One of these techniques is role-playing. For example, if a child had a traumatic experience with a police officer, it would be beneficial for the counselor to have a police officer doll, costume, or puppet to use while role-playing their interaction with the officer. The play materials become part of the experience and a critical component of the client's process.
The final core assumption in trauma-informed care is to Resist Re-traumatization. This concept applies to both client and counselor (SAMHSA, 2014). Some children who have faced traumas may be avoidant when discussing topics relating in any way to their trauma. Play therapists need to be mindful of the risk of re-traumatization. They should be cautious not to direct or push a client beyond to confront a traumatic experience. Instead, the child may benefit from a non-directive approach. One of the ways that the Adlerian Play Therapist can do this is through meta-communication. Meta-communication requires attention to detail of the child's words, play, body language, facial expressions, and more. For example, if the child is communicating that they are upset through their words or body language, the counselor could point out to the child by saying, "You are really sad/upset today." A vital factor to note is that the counselor must never force a child to talk about their trauma due to potentially causing harm to the child and re-traumatization. Instead, the counselor can create different opportunities to express their trauma.
Conclusion
Therapists who work with traumatized children face a unique challenge of integrating trauma-informed principles and core assumptions, humanistic tenets, and evidence-based modalities appropriate for a child's developmental age and nature. Adlerian Play Therapy offers a modality that encompasses each of these facets in a way that can foster the development of the therapeutic relationship, recognize and conceptualize the trauma reaction, and provide specific interventions for processing and healing from trauma.
References
Evans, C. (2021). Trauma-Informed Adlerian Play Therapy: A Case Study. Journal of Individual Psychology, 77(3), 362–373.
Kottman, T., & Ashby, J. (2015). Adlerian play therapy. In Evans, C. (2021). Trauma-Informed Adlerian Play Therapy: A Case Study. Journal of Individual Psychology, 77(3), 362–373.
Kottman, T., & Meany-Walen, K. (2016). Partners in play: An Adlerian approach to play therapy (3rd ed.). American Counseling Association. In Evans, C. (2021). Trauma-Informed Adlerian Play Therapy: A Case Study. Journal of Individual Psychology, 77(3), 362–373.
Landreth, G. (2012). Play therapy: The art of the relationship (3rd ed.). Routledge.
Scholl, M.B., Ray, D.C., & Brady-Amoon, P. (2014). Humanistic Counseling Process, Outcomes, and Research. Journal of Humanistic Counseling, 53, 218-239, doi:10.1002/j.2161-1939.2014.00058.x
Substance Abuse and Mental Health Services Association (2014). SAMHSA's Concept of Trauma and Guidance for a Trauma-Informed Approach. https://ncsacw.samhsa.gov/userfiles/files/SAMHSA_Trauma.pdf