Play Therapy — Play Therapy December 2011
Change Language:
Mindful Awareness Play
Amy Bloom Connolly Shortle

Attuning to our children involves being aware of the messages they are giving us, not just with their words, but with every aspect of their being, and adjusting ourselves to resonate in harmony with them (Kabat-Zinn & Kabat-Zinn, 1997).

Baby Anna lifts the brightly colored cloth that her mother uses to hide her face, and giggles when she sees Mom’s reassuring smile. The play therapist has encouraged Mom to play the peek-a-boo game with Anna. Although this is a simple game to her mother, peek-a-boo is important work for Anna. Observing closely, the play therapist sees the return of separation wariness in Anna when the cloth re-covers her mother’s face. Anna worries that her mother has disappeared all over again and isn’t sure if she will come back. Memory begins to build as Anna reaches forward to lift the cheerful cloth and continue this age-old separation game with her mother. She uses this parent-child play moment to rehearse the daily leaving-taking by her mother from the Nursery playroom that causes both baby and mother great distress. Mom, with the play therapist’s support, is learning to watch carefully for Anna’s reaction to her disappearance and to give consistent reassurance - “See, Mommy comes back” - as Anna continues the game. Abruptly, Anna turns away from her mother, rolls over onto the floor, and begins wiggling away. Mom looks at the play therapist and verbalizes the disengagement cue she has just observed. “Looks like Anna wants to stop the peek-a-boo game now.” As a result of the coached play, Mom can accept this abrupt change of activity from her baby without Feeling her baby has rejected her, and observes that her baby is happy and confident as she giggles on the floor beside her in delight and exploration.

Mindful Awareness Play (MAP) is a play intervention used by therapists at the PACT: Helping Children with Special Needs Therapeutic Nurseries (TN), an affiliate of the Kennedy Krieger Institute. It is implemented for babies (under 3 years) and parents experiencing homelessness to strengthen the attachment relationship and address traumainduced developmental delays. Homelessness among families is growing. Forty percent of the homeless population in the United States consists of families, with 1.3 million children experiencing homelessness annually (Bassuk et al.,

2005) . MAP seeks to help children deal with, and grow beyond, the intense separation anxiety, delayed expressive and receptive language delays, and blunted imaginative play that are the evidence of social-emotional trauma—the impact of homelessness and shelter living—on very young children (Cook et al., 2005; Norris-Shortle et al., 2006).

For the past thirteen years, the PACT: Helping Children with Special Needs Therapeutic Nurseries (TN), have provided attachment-based mental health interventions in a number of unique ways that strengthen the social-emotional development of very young children by enhancing the parent/child interactions in the high risk families within a high quality day care setting. Once a week, parents spend the morning in the Nursery building ritual and connection with their children through play and routine (Kiser, 2007; Kiser, Bennett, Heston, & Paavola, 2005). During a morning Family Traditions Group, families engage together in a catered breakfast, attachment-based circle time, a parent/ child Mindful Awareness Play activity (MAP), and a mindfulness-based parent support group (Melley et al., 2010; Norris-Shortle et al., 2006). Each Mindful Awareness Play activity builds on the ideas of parental delight in child play developed in Stanley Greenspan’s Floor Time (Hanna, 1990) and Watch, Wait, and Wonder (Cohen et al., 2002). Parents are invited to follow their child’s lead by being a Curious Observer. The play skills of Filial Therapy (Guerney, 1983) lend the clinical notion of respecting the freedom of the child to explore a simple item in whatever way s/he chooses as a Curious Explorer. The therapist is the witness for this playful dyad, supporting the parent, in the mode of Parent Child Interaction Therapy (PCIT) (Herschell, Calzada, Eyberg, & McNeil, 2002), to notice the child’s interest and restrain from Directing her play for the protected moment. As Lieberman and Van Horn (2008) targeted joint capacities for play and communication within the dyad to restore age-appropriate functioning in psychotherapy with young children, the relationship-based MAP activities integrate these concepts with the additional goal of mutual regulation through mindful self-awareness. At the core, MAP activities are specifically designed to offer children what the American Academy of Pediatrics deems essential tools for healthy brain development—child driven undirected play (Ginsburg, 2007).

While mindfulness work with preschool and school-aged children is currently being pioneered (Innerkids; Still Quiet Place; Mindful Schools; MindUp; Listening Mothers; Reflective Parenting; Mindful Motherhood; Mindful Parent, Happy Child), few programs specifically target dyads of parents and their very young children. MAP, like Mindful Parenting (Reynolds, 2003), seeks to amplify the reflective parenting aspect of the play interaction for developmental health in early childhood. Uniquely, Mindful Awareness Play was developed specifically to serve a growing, underserved, and needy population, homeless families with children under three.

Mindful Awareness is integrated throughout the TN’s programming and physical environment. These include the Family Traditions programming (breakfast, circle time, MAP dyadic play sessions, mindfulness-based parent support group), staff training, and the physical environment (murals in the rest rooms illustrate each week’s mindfulness concept). Ritual objects used each week—the resonant tingsha bells, and the eye-catching wooden rhythm frog, both used as tools for building mindful awareness and affect regulation at breakfast, in the classroom, and in parent groups—are prominently displayed. Each element works together to help parents learn and practice a self-reflective mindful awareness for themselves and with their children. Mindful awareness focuses the parents’ intention on being in the present moment, and learning to respond to their children, and themselves, without judgment, rather than reacting automatically. Siegel and Hartzell (2004) point out that mindful awareness skills are essential for a strong parentchild bond, increasing the likelihood of a healthy attachment and improved outcomes for children.

The dyadic play session follows a nurturing breakfast, and close physical contact encouraged between parent and child during Circle Time’s playful songs. In the MAP sessions, each Dyad is paired with a clinician. Every week a decorated red box containing a different mystery item is presented. Parents are coached to give the closed box to the child to explore without instruction. The clinician supports the parent in following the child’s Curious Explorer lead. This new way of interacting can, at first, feel frustrating for parents who have little control over their life circumstances. And yet, as they soon experience, allowing their child to explore without judgment creates opportunities for the emergence of creativity and innovation in the child that lie at the core of play. Exploration in play is the foundation for developing social relationships, cognitive development, and problemsolving skills (Brown & Vaughan, 2009). As Anna and her mother played peek-a-boo with the gaily-colored cloth that Anna found inside her box, the hard work of developing trust and attachment was underway. Evident joy radiated from Anna, as her mother repeatedly covered her own face, revealed it again, while each time reassuring, “Mommy comes back.”

Admittedly, each Curious Observer parent has a tough job. Delighted observation, without controlling the situation, can be difficult. Mindful awareness, or bringing fresh eyes to the here and now, pairs naturally with following a child’s lead. By releasing all preconceived notions of the “right” way to play with the hidden object, the parent immerses herself in the world of the child’s play, the child’s symbolic language (Gerber, 2002). The rewards of play may be timed to parallel synaptic neural growth, and flourish when catalyzed from a child’s natural impulses (Brown & Vaughan, 2009).

Two important elements define Mindful Awareness Play activities:

1. MAP integrates play-based mindfulness practices between parents and their children into a larger framework of experiences including a family breakfast, circle time, and a mindfulness-based parenting support program. Each week’s MAP theme is echoed in the physical environment, circle time songs, MAP activity, and the parent group.

2. MAP is specifically designed to meet the needs of young families who are homeless, and whose life experiences have been chaotic and traumatic.

Weekly concepts are infused through the morning’s programming, including the MAP activities. On the “Swirling to Still” week (when the parents will discuss the heightened anxiety of an agitated busy mind), the box contains a glitter ball to be turned, swirled, and bounced. The parents explore a fuller understanding of the glitter ball as a metaphor for their active minds during the mindfulness-based parenting group immediately following their dyadic session. The monkeys-in-a-barrel toy (plastic monkeys that can be linked together to form a chain) appears in the box during “It’s Just A Thought” week. In the mindfulness-based parenting group, parents participate in guided play with the monkeys and discuss the many busy thoughts in their mind, learning that they have choices about how to respond to those thoughts. To concretize the theme “I Can Sense When I’m Tense; I Can Flow and Let Go” and link it to the growth of love, attachment, and mutual affect regulation, that week’s box contains a squeezable stress ball shaped like a heart.

Examples of the integration of weekly concepts and MAP activities:

Case Example

Anna, the youngest of three siblings, is the first child to be reared by her mom since she became clean and sober. Mom grew up in a harsh and punitive environment. In their first days in the PACT Therapeutic Nursery, Mom responded to Anna’s separation crying and clinging with gruff and loud pronouncements to Anna to, “Stop it or I will leave.” Encouraged by the staff, Mom began spending time in the nursery, but it was primarily talking to other parents rather than paying attention to Anna.

Anna’s initial weeks in the Nursery were marked by intense separation anxiety—she ate very little, sobbed during naptime, and clutched at classroom teachers during free playtime. Mom regularly took part in the weekly morning programs, participating with Anna in the MAP sessions, with one-on-one guidance from a play therapist. Here, Mom learned about Anna’s disengagement cues, and that her crying and clinging was not misbehavior, but rather her baby’s language for “I need your help, Mom.” In the mindfulnessbased parenting group, Mom learned the importance of stopping, taking a deep breath, and observing so that she could respond to her toddler in a thoughtful, intentional way rather than her previously frustrated, angry reaction.

Anna and her mom attended the Nursery when the components of MAP and Mindfulness Support Groups for parents were introduced into the Family Traditions breakfast mornings, and both were active participants in these activities for six months. During that time, the Nursery staff documented improvement in Anna’s functioning. Using the DECA-IT (Devereux Early Childhood Assessment-Infant and Toddlers) when Anna entered the PACT Nursery she was considered a child “in need,” the lowest domain rating, in all Categories. Six months later, she had improved to the level of “strengths,” the highest domain rating, in two categories, and scored “typical” or average in the third. Anna exhibited these blossoming skills through her increased length of focus, use of creative problem solving, and new uses of play materials. As she played with her mother, she basked in the warmth of her mother’s delight in her play. Her confidence grew. Mom, and the staff, could see that during this time Anna became more at ease in the nursery, participated in all play with her peers with enthusiasm and cooperation, and napped and ate without distress. Mom was noticeably proud when Anna was finally able to smile at her Mom and wave goodbye. Anna then turned to her teacher nodding, saying, “Mommy comes back,” and ran off to play with her friends.

References

Bassuk, E. L., Friedman, S. M., Batia, K., Holland, J., Kelly, A. H. ,Olsen, L., Vaulton, W. (2005). Facts on trauma and homeless children. Retrieved from the National Child Traumatic Stress Network website: http://www.nctsn.org/ sites/default/files/assets/pdfs/Facts_on_Trauma_and_ Homeless_Children.pdf.

Brown, S., & Vaughn, C. (2009). Play: How it shapes the brain, opens the imagination, and invigorates the soul. New York: Avery/Penguin.

Cohen, N.J., Lojcasek, M., Muir, E., Muir, R., & Parker, C. J. (2002). Six-month follow-up of two mother-infant psychotherapies: Convergernce of therapeutic outcomes. Infant Mental Health Journal, 23(4), 361-380.

Cook, A., Spinazzola, J., Ford, J., Lanktree, C., Blaustein, M., Cloitre, M, van der Kolk, B. (2005). Complex trauma in children and adolescents. Psychiatric Annals, 35(5), 390-398.

Gerber, M. (2002). Dear parent: Caring for infants with respect. Los Angeles: Resources for Infant Educators.

Ginsburg, K. R. (2007). The importance of play in promoting healthy child development and maintaining strong parentchild bonds. Pediatrics, 119(1), 182-191. Doi:10.1542/ peds. 2006-2697.

Guerney, L. F. (1983). Introduction to filial therapy: Training parents as therapists. In P.A. Keller & L. G. Ritt (Eds.), Innovations in Clinical Practice: A Source Book, 2, 26-39. Sarasota, FL: Professional Resource Exchange.

Hanna, S. (1990). Floor time: Tuning into each child based on the work of Stanley Greenspan, MD. NY: Scholastic.

Herschell, A. D., Calzada, E. J., Eyberg, S. M., & McNeil, C. B. (2002). Parent-child interaction therapy: New directions in research. Cognitive and Behavioral Practice, 9, 9-16.

Kabat-Zinn, M., & Kabat-Zinn, J. (1997). Everyday blessings: The inner work of mindful parenting. New York: Hyperion.

Kiser, L. (2007). Protecting children from the dangers of urban poverty. Clinical Psychology Review, 27, 211-225. Doi: 10.1016/j.cpr.2006.07.004.

Kiser, L. J., Bennett, L., Heston, J, & Paavola, M. (2005). Family ritual and routine: Comparison of clinical and non-clinical families. Journal of Child and Family Studies, 14(3), 357-372. Doi: 10.1007/s10826-005-6848-0.

Lieberman, A. F., & Van Horn, P. (2008). Psychotherapy with infants and young children: Repairing the effects of stress and trauma on early attachment. New York: Guilford Press.

Melley, A. H., Cosgrove, K., Norris-Shortle, C., Kiser, L. J., Levey, E. B., Coble, C. A., & Leviton, A. (2010). Supporting positive parenting for young children experiencing homelessness: The PACT Therapeutic Nursery. Zero to Three, 30(3), 39-45.

Norris-Shortle, C., Melley, A. H., Kiser, L. J., Levey, E., Cosgrove, K., & Leviton, A. (2006). Targeted interventions for homeless children at a therapeutic nursery. Zero to Three, 26(4), 49-55.

Reynolds, D. (2003). Mindful parenting: A group approach to enhancing reflective capacity in parents and infants. Journal of Child Psychotherapy, 29(3), 357-374. Doi: 10. 1080/007541703100016255413.

Siegel, D., & Hartzell, M. (2004). Parenting from the inside out. New York: Jeremy Tarcher/Penguin.

About the Authors

Amy Bloom Connolly, MS, is an independent mindfulness educator in Baltimore, Maryland, helping people build resilience and self-regulation through her mindfulness-based SHINE (Support. Honor. Inspire. Nurture. Evolve.) Programs. Abcshines@gmail.com

Kim Cosgrove, LCSW-C, is the Director of PACT: Helping Children with Special Needs Therapeutic Nurseries (an affiliate of the Kennedy Krieger Institute) for Homeless Infants and Toddlers and their Parents, and a clinical social worker specializing in attachment and in-home intervention therapies in Baltimore, Maryland. Cosgrove@kennedykrieger.org

Carole Norris-Shortle, LCSW-C, LMFT, RPT-S, is faculty in the Taghi Modarressi Center for Infant Study, Psychiatry Department, University of Maryland School of Medicine, in Baltimore, who integrates attachment, play, and mindfulness theory in her clinical work at PACT: Helping Children with Special Needs Therapeutic Nurseries (affiliate of Kennedy Krieger Institute). Norrisshortle@ verizon.net

Susan A. Taylor, CMA, LGSW, has worked with parents, children and adolescents in the Baltimore- Washington region using breath, attention, observation, movement, intentional touch, play, and music since 1995. Susan@susantaylor.info
VIEW ALL ARTICLES
Message
SEND