Technique Toolbox - Teaching a Child to Self-Regulate

I work with a lot of kids, and a lot of whom come from really traumatic backgrounds. As a result, they have a lot of emotional problems and have trouble self-regulating when their world gets out of whack (which it often does).

Children, being developmentally slower intellectually, don't have the words to express themselves when they are upset. Very young children cry, and older children tend to scream and have tantrums. It's important to intervene in a child's life and teach the the very important skill of self-regulating as early as possible.

At a conference I attended, I found out one of the simplest interventions you can do with a child to get the point of deep breathing across to them. I've not used this with my 3-year-old yet, but I plan on it. So if you've got children in your novels having a difficult time calming down or stopping tears, give this a shot.

What you will need:

An index card
Markers
Laminating machine (if possible, to make the card last longer)

What you do:

Have the child draw a picture of a flower on one side. As they draw, explain that to really appreciate the beautiful fragrance of a flower, you have to inhale deeply. Demonstrate with an exaggerated expansion of your chest cavity.

Then have the child turn the index card over and draw a picture of a birthday candle on a piece of a cake. Tell the child about what a deep breath is needed to make sure the candle is fully blown out. Exhale with them, practicing to blow the candle out by directing your outward breath to the card.

Purpose:

Children have to learn what breathing can do for them when they are upset. Getting oxygen to the brain can help sooth the child, make them more rational and alert. Most people tend to breathe in shallow breaths, and practicing doing this automatic function with a different method is useful. Breathing through the nose gets the oxygen in faster because people tend to inhale more deeply when doing so by their nose anyway.

Children can learn to calm themselves (called self-regulation) by using this two-sided card that fits in their back pocket. Some kids get so upset that they are red-faced, crying, and unable to speak, even if they should want to. Helping them see that moments like that are the perfect time to get the card out and practice self-soothing with deep breathing.

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Technique Toolbox - FREE DOWNLOAD ADHD scales

Vanderbilt ADHD Diagnostic Parent and Teacher Rating Scales

Credited to:  Mark L. Wolraich, MD, and colleagues

For use with: Children

What you will need:

downloaded scales
writing instrument
scoring instructions
time to observe the child

What you do:

Download the Vanderbilt ADHD Diagnostic Parent Rating Scale here.

Download the Vanderbilt ADHD Diagnostic Teacher Rating Scale here.

Typically a clinician will give each of the scales to the appropriate person, either teacher or parent. That person, then, observes the child in either the home or school settings, checking things as they apply and using the scoring details to determine the child's propensity in that setting.

(These are GREAT scales to have on standby to determine if your character meets the criteria for ADHD as well! Bonus, right?)

Purpose:

Making the correct diagnosis in pediatric attention-deficit/hyperactivity disorder (ADHD) is especially important today. The Vanderbilt Rating Scales closely follow the criteria set forth in DSM-IV (Diagnostic and Statistical Manual 4th Edition) and have been customized to observations made in the home and classroom environments (thus the Parent and Teacher scales).

When the forms are returned to the counselor, the scoring allows the clinician not only to make a diagnosis of ADHD, if present, but also to categorize the problem into one of its various subtypes: inattentive, hyperactive/impulsive, or combined. The Vanderbilt Scales also look for symptoms of other disorders that are commonly found in children with ADHD, such as oppositional defiance, conduct disorder, anxiety, and depression.

Hope you find them useful!

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Technique Toolbox - Inside/Outside Bag

 Inside/Outside Bag Technique

Credited to:  I have no idea.

For use with: Children or Adults, Groups/Individuals

What you will need:

school lunch sized paper bags, enough for all clients and therapist
old magazines, a variety is best
scissors
glue/rubber cement/tape


What you do:

Instruct the client(s) to cut out 8-10 things (or more, if time allows) to go on the outside of the bag that represent something about themselves people could see or know just by hanging out with them. This would include descriptions, things the person likes or enjoys, like favorite foods, clothes, electronics, and movies.

At the same time while the client is flipping through magazines, tell them that they need 8-10 cutouts for the inside of the bag, and these cutouts will represent things about themselves that people wouldn't necessarily know just by looking at them or hanging out with them. These items might include the make/model of their first car, a crown to symbolize a pageant they wont as a child, a dislike of a government figure--but usually something meaningful.

After everyone has assembled their collage on the outside and put the inside cutouts loose inside, then you have the client(s) explain his/her bag, going through each cutout and saying a bit about it, unless it's pretty self-explanatory (i.e., a client put a Coke bottle on the outside of their bag because they like Coke).

Purpose:

This intervention is a great ice breaker for groups or individual therapy sessions. I typically will do this exercise once with almost every age-appropriate client I have, because it serves to let me know something about them and them to know something about me.

(Caveat: I'm careful what I put on the inside of my bag, so as not to be too polarizing. For example, in a recent bag I did, I cut out a picture of a diamond ring to put inside my bag and when explaining it, I said that I had designed my own diamond wedding ring. True, but not something that will turn a client against me.)

This kind of intervention is also relaxing, and group process can be strengthened easily by encouraging the participants in the group to engage others while flipping through magazines, calling out various things they see that others might want to claim. Talk around the table can easily turn to serious things while people are cutting and pasting away, which gives opportunity to process.

Fun technique, people, and it can be vastly entertaining and revealing about people.

If you missed it, you can click here to see my devotional post on Jennifer Slattery's Live Out Loud blog.

Technique Toolbox - You Are Special by Max Lucado

You Are Special Technique

Credited to:  Malinda Fasol, PhD, LPC

For use with: Children or Adults

What you will need:

A copy of Max Lucado's You Are Special

What you do:

I usually will read this book aloud to both children and adults. I like to sit at an angle where the client can see the pictures as I read to them.

The book is about the Wemmicks (wooden people created by Eli, the "carpenter on the hill"). They go about all day long, every day, giving each other stars and dot stickers. Stars for being talented or pretty and dots for being clumsy or having chipped paint. Punchinello, the main character, only gets dots. He meets Lucia (who looks much like an angel, all dressed in white) who has no stars or dots. Lucia says that she visits Eli at the top of the hill often, and the stickers don't stick to her no matter what, because Eli's opinion of her is all that matters.

Punchinello takes Lucia up on her suggestion and begins to visit Eli. Eli tells him how important and unique he is, created just by Eli to be that way. On Punchinello's way out of the workshop, one of his dot stickers fall off as he begins to believe that Eli really means what he says.

After the book, I typically ask at least these 3 questions (sometimes a few more, based on their answers):

1) If you were a Wimmick, would you get more stars or dots?
2) Can you tell me what 5 of the stars/dots would be for?
3) Do you have a Lucia or Eli in your life?
 
Purpose:

Question 1 gives me an understanding of how the child or adult sees him or herself. I can assess their self-esteem based upon the answer to that question.  Question 2 is a cognitive exercise that has the client labeling what's good (or negative) about themselves. This can prove helpful in determine goals for therapy with adults (ostensibly to improve self-esteem or overcome a fear). Children will often parrot back what they have been told from friends or family members. Question 3 tells me what kind of support network the client has.

This book is not overtly Christian. Lucado wrote it from a Christian perspective, though, and I find it's a great way to introduce Christian principles into session without ever saying the words "Jesus" or "God."

From Max Lucado's website: The world tells kids, "You're special if... if you have the brains, the looks, the talent." God tells them, "You're special just because. No qualifications necessary." Only one of those messages will find its place in their hearts. That's why every child you know needs to hear this one, reassuring truth: "You are precious in His sight."

This is a great little technique to make its way into one of your novels. And if you haven't read You Are Special, give it to a child for Christmas this year. Wonderful, heartwarming story. There are several books by Lucado about the Wimmicks you might also want to consider.

Technique Toolbox - Storybears

Storybears Technique

Credited to:  Creative therapists utilizing Melissa and Doug toys

For use with: Children; Especially effective with children with both maternal and paternal roles filled in their lives

What you will need:

Melissa and Doug Family Dress-Up Puzzle ($11 from Amazon)


What you do:

The therapist introduces the little wooden box with three sets of puzzles, one for the "papa," one for the "mama," and one for the little guy/girl. They come with corresponding shapes on the back of each piece so you know this head belongs in the "father" pile because it's got a triangle on the back or this set of feet belongs with the "mother" because it's got a tiny circle on the back.

I usually explain that I want us to tell each other a story (also called mutual storytelling), and I'll sometimes begin the storytelling if the child is at all apprehensive or unsure of themselves, generally picking a story that corresponds to something I know the child is going through.

Each puzzle comes with a variety of outfits (like pajamas, swimsuits, work clothes, baseball outfits, etc) that the child can mix or match, but the most important thing is the faces. There are 6 faces that depict varying emotions of joy, contentment, sadness (with tears and usually accompanied by a bump on the head or a thermometer), disgruntled (mildly displeased expression), angry (very obviously mad expression), and sleepy (eyes closed). Of course, any expression could be interpreted in any way the child wants.

I will let the child put all the pieces together on the top of the puzzle box (they fit in grooves) before listening to their story (or telling mine).

Purpose:

Children are free to express what is going on in their own family through telling a story about the bears, which removes the personal element and frees the child to be as detailed or honest as they want without fear of repercussion for talking directly about his or her family.

When the therapist picks a very relevant story to the child's current situation, the child will many times nod that they felt the same way, identifying with the child bear, or that their own father acted the same way the bear's father acted in my story. Then this opens up the session for further discussion about what the child did or how he or she felt.

I will also allow the child to change out the bear faces (or outfits) to make the scenario something he or she would like better, to end on a hopeful note. I might share this information with the parents later if I think it might help.

Another great reason for doing this with young children is to aid in emotional recognition. I will leave out the storytelling element altogether and just have the child play with the puzzles, commenting on each face and the features that indicate what the bear might be feeling. I can even have the child practice these same features utilizing a mirror and modeling a smile or angry look myself.

Hope this helps makes those therapy scenes more realistic!

Technique Toolbox - Draw a Person

Draw a Person Technique

Credited to:  Florence Goodenough and Dr. Dale B. Harris

For use with: Children

What you will need:

3 pieces of paper
pencil

What you do:

The therapist requests the child to complete three individual drawings on separate pieces of paper. The original instructions require the child to draw a man, a woman, and themselves. I learned it in that the child is asked to draw a person with no other instructions given. If the child draws a man, then the next drawing would be a woman, or vice versa. The final drawing would be a self-portrait. It is preferable that the child draw the whole person each time, head to foot.

The therapist can then "score" the test using a rubric found in Harris' 1963 book. Points are given for various details, such as having 5 fingers on each hand, eyelashes, teeth, or having a proportionality that is feasible.

Purpose:

This is a non-invasive and non-threatening test and it's original purpose was to determine cognitive developmental levels without being influenced by other factors such as language barriers or special needs. The projective nature of the test came about later and were not endorsed by the creators.

However, I've found those projective measure to be spot on many times with the children I've worked with. For example, a child who draws a highly sexualized picture, with eyelashes, lips, jewelry, make-up, etc., typically have some background of sexual trauma. This is a good indication of it.

Also, I like to take the drawing of the child and the drawing of the same-sex and compare them. It's a good indicator of how the child sees themselves--and thus their self-esteem--when you do this. Children unconsciously project this into the drawings, sometimes drawing themselves really small or their feet or some other specific body part really big.

Funny FYI - When my supervisor first did this test on me in supervision, I drew my friend who worked with me as the other female drawing. When compared to mine, clearly, she was FAR more endowed than I was. Being honest, this is exactly  how I felt!!

Technique Toolbox - "Trashie"

 "Trashie" Technique

Credited to: 101 Favorite Play Therapy Techniques

For use with: Individual therapy with children with behavioral/emotional problems, family therapy with child and parents present.

What you will need:

small trash can with swinging lid (can be found at Dollar Tree for $1)
8 1/2x11 paper cut into fourths
crayons/markers

What you do:

Whether in an individual or family session, the therapist hands out usually 3-4 squares of blank white paper, already pre-cut, to everyone present. With the trashcan placed in the middle of the table, the therapist introduces "Trashie." (Trashie was so named because a client of mine decided that was to be the trashcan's name....and it stuck. My Trashie doesn't have a cute little face like the ones pictures here.) The therapist can say that Trashie only "eats" pictures of things that make the child (or family) sad, mad, frustrated, disappointed, etc. Trashie will eat any negative emotion.

Have the child or parents draw pictures then utilizing markers, crayons, etc, and then take turns explaining each other's pictures before "feeding" them to Trashie. For younger kids, I usually make a show about Trashie eating the pictures, complete with snarls and growls and burps of contentment. I explain to parents prior to the session starting that I want them to focus on an aspect of the client's behavior that is troublesome, and then I'll process with the child about hearing their parent discuss as aspect of their behavior that makes the parent sad, mad, etc. Then we discuss how it felt to "feed" Trashie those negative emotions.

Purpose:

Trashie is essentially a ritualistic creative activity designed to free the child from negative emotions that might play continuously in his or her head. It's also a safe place for parents of children with problematic behaviors to open up in front of their children to talk about how the behaviors make them feel. Since this is done process-style, not favoring one person over another, children are not as threatened by receiving the information this way than they would be if the therapist were just to have the parent tell the child outright how their behavior makes them feel.

It's therapeutic for the child (and parents) to crumple their drawing up and stuff it in the trashcan, as well. Symbolic of releasing that emotion or letting Trashie deal with it instead. With older children, I'll remove the top of the trashcan and see if they can make the paper ball shot from further and further distances. Remember, therapy is supposed to be just as fun as it is serious at times!

Shoot me an email if you ever decide to use this technique in a book. It's one of my favorites!

*** "Trashie" is not copyrighted by Jeannie Campbell, but you better not use it.***

Technique Toolbox - Magic Art

Since we looked at an adult technique last week, we'll alternate with a children's technique this week.

Magic Art Technique

Credited to: Ruby Walker, 101 Favorite Play Therapy Techniques

For use with: Children, toward the very beginning of play therapy, to establish a positive feeling toward therapy and work with the therapist. Can be used individually or in a group.

What you will need:

construction paper in a wide array of colors
liquid tempera paint in a wide array of colors, in bottles with very small opening
glitter (optional)

What you do:

Allow the child to select whatever color paper (s)he chooses. Tell the child that they need to use at least 3 different colored paints to make a magic picture, making dots or lines or any figure they choose. The therapist will praise and reinforce the child's selection and usage of the paper/paints.

After the child has used as much/as little paint as they want, then you have them fold the long ends of the paper together (like a book). Say, "Magic picture, what will [insert child's name] draw today?" The child is then instructed to unfold the paper, creating a Rorschach inkblot-like picture.


Ask the child to describe the picture as a whole or to tell what (s)he sees in the picture. Ask, "What makes it look like a _________ to you?"

Purpose:


There are many! The child is free to choose whatever paper/paints/glitter (s)he wants and apply them however they want. Children who have control issues love the freedom to choose and lack of control over what the magic picture will look like. This technique boosts self-esteem as the children create a successful picture to keep or give away as a token to mom/dad/friend.

The selection of color and intensity with which the child engages in the art tells the therapist the emotional reactivity of the child at the time of creation. The projective part of the technique focuses on what the child says/free associates about the picture and his/her feelings as maybe being indicative of their inner thoughts/feelings.

One great way to use this technique is to explain divorce to a young child, to try to instill a sense of hope that something positive can come out of the situation. What Ruby Walker does is have the child start to paint a caterpillar with the paints, and then as they fold the paper, the caterpillar is in the cocoon and "emerges" as a butterfly when the paper is opened again. This characterizes how things can be different, yet better.

Hope this technique finds a way into some of your novels!