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Doctor Eliana Gil has been on a quest to integrate trauma informed practices with neuroscience and has studied attachment based therapies like the Circle of Security and Theraplay. Working with Dr Bruce Perry, with a background in expressive therapies, Dr Gil is an advocate for Theraplay (along with many of her peers from Dan Hughes and Besel Van Der Kolk to Daniel Siegal and Stephen Porges). We learn from her about Theraplay and play therapy and the quick wins, the long haul and the principles to follow. She reminds us that those who love us hurt us, and this is why children need time and safety to move on from past trauma. Dr Gil kindly shares with us real life examples of how traumatic experiences come up in the play, including examples of physical and sexual abuse, divorce, natural disasters, grief and domestic violence. She teaches us that play is a powerful tool where children can begin to heal by using metaphors. She reminds us that unwanted behaviours are not rejection, but questions and that you need to depersonalise them as these children take a long time to heal. A year is not enough for sufficient experience to build new connections in their brains. Safety and connection must be honoured. And the great thing is that by providing safety and connection, families can do things that help the child and the process of recovery. She reminds us it will not be permanent.
00:00 - Start 00:35 - Introduction to Doctor Eliana Gil 02:54 - How to help us understand the value of play in a play therapy 07:07 - Main principles: treat the relationship 10:49 - Have patience - one year is not sufficient to reverse what has happened earlier 13:00 - Behaviours are not rejection, but questions, so depersonalise unwanted behaviours 15:18 - Children bring trauma to therapy - an example of physical abuse 16:56 - Children bring trauma to therapy - an example of sexual abuse 19:39 - Remember the trauma behaviours aren't permanent 19:55 - Examples of the play 20:35 - Example of domestic violence in children's play therapy 22:54 - Example of natural disasters in children's play therapy 24:15 - Example of divorce in children's play therapy 24:55 - Start play therapy by discharging feelings and communicating using metaphors 25:58 - Example of grief in children's play therapy 28:12 - Quick fixes with theraplay 31:27 - Bruce Perry and the importance of coregulation and movement 33:25 - Homework and what can be done at home to help the child 34:54 - Where to find a theraplay practitioner 37:49 - Safety is the treatment for the child and connection is really, really important
This is Sonia Wagner, representing PCA Families in one of our recordings that capture lived experience and best practice evidence based learning that assist kinship, permanent and adoptive parents/carers in supporting young people. PCA Families has a zero tolerance of child abuse. I would like to acknowledge the traditional custodians of the land on which we meet and pay respect to elders past and present and express our intention to move together to a place of justice and partnership.
Today we are speaking about Theraplay with Dr Eiana Gil.
00:35 Who is Dr Eliana Gil?
Dr Eliana Gil is a Registered Play Therapist Supervisor and Director of the Gil Institute for Trauma recovery and education. Dr Eliana Gil has been on a quest to integrate trauma informed practices with neuroscience and has studied attachment based therapies like the Circle of Security and Theraplay, and has been working with Dr Bruce Perry to obtain individual certification. She also has a background in expressive therapies and we are delighted to learn from her today.
I am bilingual, bi-cultural, from South America and emigrated to the United States when little. So Spanish was my first emotional language. So when I experience trouble in any way I shift to Spanish. So that gave me a real appreciation for how we can communicate with others without language. So a lot of what I do with kids is trying to do that. When kids come to therapy they don’t knock on the door, sit down and say let me tell you what I’m thinking about. We need to invite them into communicating with us in whatever way works for them. So I always say you can talk to me but we have lots of other ways that you can show me what’s on your mind. That’s why I pursued some of the expressive therapies, to give kids a way of communicating because we often rely too much on language.
Often it’s not what you are saying but the other things going on around you.
02:54 Theraplay is a child and family therapy that many of your peers advocate for, including the likes of Stephen Porges, Dan Hughes, Daniel Siegal and Besel Van Der Kolk. In essence the treatment is about play. So how do we get families to understand the power of play, and the outcomes available to them, especially for children with traumatic starts?
I always believe in my heart of hearts that the best way to expose someone to a concept is to let them have an experience with it. A brochure doesn’t go far enough. What people need is an opportunity to have the experience. During intake I will invite them into some form of play. I might ask them to show me who lives in the family and instead of just writing down names we will do that by selecting miniatures and these miniatures can show how you think and feel about people in the family. It's amazing people will do something very simple like that and they immediately say I had no idea that so much could come out this way So the experience is really important.
I’ve also had situations where families are mandated into treatment. They don’t want to be there and they don’t understand why or they disagree with how other people view them. I say to them I understand completely as I have a hard time doing something others think is good for me. You know lets just stand up for a second and I have a balloon here and all I want you and your family to do is hold the balloon up in the air. I don’t say anything else and then they start trying to keep the balloon up in the air. Then I add a second and a third balloon and you can see the level of difficulty but also the level of physical movement and breathing and suddenly their bodies are in different positions and now they are excited. So then I take the fourth balloon and the third and the second and leave them back with one and we sit down and I say what was it like to just have one balloon to hold. What was it like to have four? And now I have a receptive family. It was unexpected as a novelty was involved where they can relax and get out of their heads and get out of anxious expectations about what’s going to happen here.
The experiential component is really important and the surprise element is really important. I describe myself as a family play therapist. At any time just expect you might be participating but Id also like to get to know your child first. I prefer to make a connection with the child and then move into dyadic work or family therapy or whatever is appropriate based on a really good assessment. Play is always part of what we do that advances some of the overall goals that you have.
7:07 So what are the main principles that need to be followed in theraplay? The science behind it?
If we are talking about theraplay it is always dyadic. It looks at 50 years of research on attachment and looks to establish or strengthen a secure attachment between a parent and a child. They have studied secure parent-child dyads and identified the basic elements of securely attached dyads and then they give the parent and child opportunities to do those activities that are intuitive in parents sometimes and other times have to be encouraged. It treats the relationship. That’s the great thing about play. It’s not like the child needs to be fixed in any way. It’s a relationship that almost always can be strengthened. There are always areas you can buffer up and strengthen in the relationship.
Most of the time with adoption or kinship there have been experiences with other caretakers. Even if they may have been adopted as babies, they have been carried in the womb and had different experiences going on that can affect children. A lot of times we have histories of trauma, losses and disruption in attachment. Often times children come in with expectations of its going to be great to be with a parent or I’m scared of that person and why is that person getting close to me. That can be an unconscious process – something the body learns about the safety of being with another person.
So theraplay allows children to have these experiences that are rewarding, dynamic, nurturing and playful experiences, all while doing it repeatedly so that the child can begin to trust it is going to be ok. In the attachment world they talk about the child’s internal working model. All that means is that the child develops an expectation of the world as rewarding and caring or threatening and dangerous based on whatever experiences they have had. The lesson of child abuse is that people who love you hurt you.
So if a child start to feel loved straight away, their anxiety may increase as their expectation is that this will be accompanied by something painful. So it’s a very difficult situation. As parents we are intuitively trying to do the most loving nurturing thing we can do and that’s the very thing that sometimes can make a child feel frightened.
10:49 Patience
One of the things I notice a lot with families where there has been adoption is the timing of things. Let’s say they can have a child for a year. Let’s say you adopted the child at six and now you have the child for a year and you are going well it’s been a whole year that he has been safe and loved and we are having really good experiences. Why do they continue with a, b or c? Well a year is a drop in the bucket in terms of sufficient experience to reverse what has happened earlier. Patience is so important in working with children with trauma histories. We have to repeat and repeat and repeat and not get tired of repeating something because that’s the only way the children are going to build new connections in their brain and make new associations and change expectations. Sometimes parents get frustrated because they are working overtime to make the child feel safe and yet the child is still a little bit uncertain and ambivalent. They like to test the limits. Oftentimes these children are very resilient children for the most part and really want to trust the other person. So that's the thing that's so surprising that even after let's say five or six or seven disruptions in care that child still goes into a new home with an expectation or a hope that something will feel different there. I do think they're very resilient and they want to have the connection but that connection is very anxiety provoking at times and so they need a lot of reassurance and repetition.
13:00 Unwanted behaviours are not rejection, but questions, so you need to depersonalise them.
One of the things I learned the most from Bruce Perry is how important repetition is. He says we can do therapy once a week with a child but if a parent takes a child and rocks them for 10 minutes every night, that is going a whole lot farther than any therapy. Once the parent realises how much they are really needed by the child, when they realise these are not rejections but they are questions, or that these deeply seeded lessons they have learned in life experiences, they can de-personalise it and begin to shift and be the steady person who repeats and repeats. Believe me its tiresome. You wonder how much more do I need to do but at some point the child shifts. Something happens internally and they can feel safe int her mind, body, heart and soul. The connection is finally strengthened enough that it feels like an anchored connection.
I think that's why we talk so often to our families about that self-care aspect because it does take so long so it's important to get that kind of time out and that help for self-care.
Depersonalise this so that it isn’t you as the person that the child is trying to push away. So viewing this with a different lens. It’s the unsafe feeling they have in that moment that they want to stop. Depersonalizing this and viewing the behaviour with a different lens is important.
15:18 Children bring trauma to therapy
Physical Abuse
In therapy I was working with a little girl as she has been seriously physically abused for many years. We worked together and at the end of six months she brings me a ping pong paddle. I said what’s this? She says that’s a ping pong paddle for you to hit me with. I looked at her and said why would I want to hit you. She said well you like me don’t you? So in her mind the next thing that was going to happen was that I would do something bad to her. So I said to her I’m not going to hurt you in any way. This became a repetitive mantra. In this case no. I said I can see sometimes you have learned that when somebody loves you that it comes with this pain but that’s not going to be part of my liking you. It took her another 6 months for her to feel that that was true and I wasn’t going to hurt her. We did have to set limits because sometimes she would throw things at me or something like that. I'd just say you know that's just not safe for either of us so we have to come over here and sit down and just kind of calm down a little bit before we can return to trying to play ball or doing something else, but in a safe way.
16:56 Sexual Abuse
Another child came in and she'd been sexually abused by a woman, by an Aunt. We went into the first appointment and she took her underwear off and she spread her legs. You know in those moments you say to yourself oh my goodness what do I do? Nobody ever told taught me anything about this kind of behaviour. I said you know this is a place where I keep my underwear on and you keep your underwear on so let's put the underwear back on. I just gave it to her and she just put it right back on. But that behaviour was so important because she was showing me from the get-go that this is not a safe place for me and chances are this is what you're gonna do so let's get it over with. It's somehow taking a little bit of that opportunity to master something by being the one that controls it. Like here's the ping-pong racket for you to hit me with. So a little bit it's saying I don't want to be worried about when you're going to do this so let's just do it. It's not conscious. It's not like they're thinking it out but somehow that's what ends up happening.
So in care the kids will go in sometimes if they've been sexually abused and they touch siblings or parents in a way that's inappropriate. But what they're doing is testing is this a safe world for me? They're saying we are your parents or we are your brothers or we are a family and well families usually do this stuff so let me check out if that's going to be part of what's going on. I always say to the parents that this is a great opportunity for this child to finally learn that some people will say no that's not appropriate. I can see that you're wanting to say hello or you want to be close to me. I'll show you different ways we can do that but touching private parts is not part of that. You just have to say that you know sometimes over and over and over and eventually the child can begin to relax.
I think it shows a child who's saying you know let's get this part over with and let's move on to something that's not going to be so painful or so confusing for me. So again looking at these behaviours as suggesting something more than just being quote “inappropriate”.
19:39 Its not permanent
It's not a child that's going to have this behaviour forever.
That's the other thing when working with adoptive parents I always say this is not a permanent behaviour, but it's going to be a temporary kind of checking out of limits until the child feels like they are okay. Until they can relax and know that's really not going to happen here.
19:55 Do you have a few examples of where theraplay has made a difference in the lives of children formed through kinship, adoption or permanent care? I find practical examples of the play, responses given and how that develops over time are really helpful to understanding where it might make a difference in the life of your own child.
Moving a little bit away from theraplay now, which is so much more interpersonal and kind of playful between a parent and a child where they do lots of activities, but when you're doing play therapy often we have toys and those toys are there to help the child communicate without language without verbal language.
20:35 Domestic Violence
For example a little four-year-old child comes in and she's observing domestic violence at home and she comes in and of course she knows why she's there because daddy hits mommy. I may have said something to her like I understand this has been happening and I'm sorry about that. This is a this is a place for you to kind of look around and explore and do the things that you want to do. From time to time i'm going to bring in activities for us to play with. However you know therapists might explain that to kids and then the idea is just to look around and see what you find. That four-year-old found the dollhouse and right away she put the mommy under the bed. It was a little bear. So there was a daddy bear, a mommy bear and then two baby bears. The other baby bear was in a crib and the baby was crying. The mother was under the bed and the little girl was trying to lock the door so that the dad couldn't get in. What happens in that situation of play is that if I had said to the child directly how do you feel about your dad hitting your mum or what's it like to see your mom getting hurt, chances are the child will go I don't know. Or they just won't. They just won't. I mean they're little and they don't have the language. However, what happens with toys is that they get to find something that becomes a symbol and it gives them the safe enough distance. So my daddy's not mean and hurting, but the daddy bear, that daddy bear is hurting the mommy and that baby is crying and she's scared. The mummy is hiding from the daddy bear because he's going to come in and find her. So they make up this whole story which is their story but it's being done at a safe enough distance. Now I can say what's it like for that little baby to be crying and crying. I wonder what the baby wants to say. Or I wonder what could help the baby? You just kind of do the therapy in the context of that play. So it's really lovely to watch.
22:54 Natural Disasters
I remember being little for example and I was in South America where we have lots of earthquakes. So I was very terrified of earthquakes but I found that after the earthquakes I would invent a little dance called the shimmy dance. I would say I’m gonna shake the way the house shakes and then I would just let my body dance like that and people would laugh. Everybody was together and suddenly we weren't so frightened anymore. But that's just completely intuitive and children have this ability to be able to externalise some of the things that are going on for them.
There were a bunch of play therapists that went to Haiti after a tsunami. It was amazing to watch that. The little kids they went around and through the rubble collected like little cans and things and they built the village in the sand. That was completely spontaneous but that constructive task is actually very reparative. You can't do anything with the rubble that is there. The destruction has occurred but personally you can reconstruct something and that gives children a sense of mastery.
24:15 Divorce
A little a boy eight years old whose parents were divorcing and he was very stressed. He was distressed and so he took a toilet paper roll and he just wrapped the mother and father figure together with a whole thing of toilet paper so they couldn't get out of there. Does that change their divorcing? No. However it gives him a sense that in his imagination, in his pretend world, he can keep them safely huddled and cuddled together together during this very distressing time. For whatever reason that causes some relief for the child.
24:55 We start the therapy by offering an opportunity to discharge feelings and communicate using metaphors
Because we now know of the benefits of play for problem solving and for you know discharging feelings and for communicating and for socially interacting with others. So we say let's give the kids an opportunity to do that which is their first language and then let's see if we can understand them better. See what we can respond to and in turn that might actually create opportunities for them to come to a different understanding.
Usually it's done all in metaphor, so we're talking about the baby bear or you know how to make this forest more safe for the forest animals or whatever it may be. So that's why I love play. Art is similarly very attractive to children. They start drawing and if you don't give them a task like draw a picture of a tree and you just let them do whatever is on their mind, oftentimes you get images that are really important to them.
25:58 Grief
I had one little 12 year old and he drew hands holding each other. He was grieving the loss of his mother. His mother had died but in his mind he was trying to stay connected. That was completely spontaneous. That comes from the right hemisphere of the brain and it's something that helped the child and helped him feel better and more connected to the Mum. He took that with him. At the end of the treatment with that child and his adoptive family we did an exercise where everyone picked their colour and made these hand prints. The only directive was that all the fingers that everyone imprinted had to be touching someone. They made this really beautiful circle of all the fingers and somehow for this child that was reminiscent of this hand with his mum. Then as they were finishing this up the child decided to put some shadows in the background. Sure enough the shadows were a thing representing the grasping hands. I knew that and he knew that and he didn't say anything more than that but it was just incredible to watch. I think kids have within them this great capacity to heal themselves or to know what they need or what might be helpful to them sometimes. That's our job is to just help them find that which is helpful and then once we know what that might be, whether it's writing or singing or listening to music, or whatever all these expressive worlds provide, then we can try to create opportunities for them to have more experiences like that.
You've got me reflecting on some early childhood education that I did and I'm now kind of thinking it would be nice to get more insight into those other things to look for in the play. Teaching that. Things might have changed since then. What you're talking about is there's so much more that we can be looking for in in those moments. I believe that's true.
28:12 I believe any therapy we are looking at for children with trauma, logically means we are in it for the long haul, because of where their brain is at and where we need to meet them so that they feel safe and connected so that they may learn. Often families are also after a quick fix or a quick win. Does Theraplay offer this quick win?
At times you know it's interesting. I do think that you have almost like waves of progress. For example, with theraplay, because theraplay is really about the relationship and it's about giving the parent and the child an opportunity to do sweet things with each other that maybe they don't ordinarily do or don't have the time to do. Really everything about theraplay is so simple, deceptively simple. For example, taking a cotton ball and blowing it from your hands into the child's hands and then the child blowing it back. It's such a simple little thing and yet a lot of times parents haven't taken the time to do something like that. That’s what i value so much about theraplay. It's so simple anyone can do it. It takes a little encouragement because sometimes the parent may not feel comfortable and sometimes the child may not feel comfortable, so laying down little steps towards each other works really, really well.
I can do 12 sessions of theraplay and see tremendous progress in that. I mean we've had situations where all of us in our office notice a parent that's particularly harsh with a child in the waiting room. You do a period of theraplay and you go out and you see the parent now holding the child in her lap reading a book. It's like night and day. They are both now motivated towards each other and they're having rewarding experiences with each other. So you can implement some therapies and see really quick results but that doesn't mean that you stop there. You keep trying to deepen that a little bit more.
Sometimes people come back to therapy. I've seen this happen with equine therapy or animal therapy. With kids it really makes a huge difference in their central nervous system just in terms of how they are experiencing themselves differently. I have moments with kids where the play is incredible and they're making real strides in their own reflection. Whether they tell me or not their behaviour changes. Then there are periods where it just looks like nothing is going on. Kids pace themselves.
I do think there are periods where there can be some really good changes and that's usually when parents say okay well they're ready to go now. I always go oh no we're just starting but that's okay. Then they can come back and we can do another layer of the work. It is so time-consuming. I also think that there can be progress in very specific area.
31:27 Bruce Perry and Coregulation through Movement
I wanted to add one more thing. This training I did with Bruce Perry, the most important thing about that is that all the therapies that we've designed work. What he says is you just have to apply them sequentially based on the child's brain and what's going on in their current life situation. So if I have a child who comes in and their anxiety doesn't let them stop walking around the room I can't sit there and do psychotherapy because their cognitive ability, their prefrontal cortex, is not online. So I may have to do something like blowing balloons or anything that maybe has the body involved so I can begin to co-regulate them. Sometimes it's simple stuff like just blowing a bubble and letting them watch the bubble and then saying okay now next time I send you a bubble see if you can pop it. Pop it with your hands and next time pop it with your elbow and then with your head and then the physiology of the child changes. Once that happens then you can think about the cognitive behavioural work which is also so useful but is just not usually my starting place. I want the other parts to sort of be in a different place. The other parts meaning the child sense of safety and trust and comfort and emotional availability.
I do see kids who can tell you exactly what you want to hear. They're kind of therapy savvy. You know they come in and they kind of know what to say to get out of there as soon as they can. So I really want the time to kind of get to know the child then I can kind of look at here's what I think will work with this child, with this family and so forth and so on.
33:25 Do families do homework? What sort of things do they do that help the process?
Absolutely and so behind the scenes I’m coaching and I'm doing some coaching designed to give the parents some ideas. If I give them simple theraplay activities to do at home I might say to them you know this place I want you to come in and I want you to watch what it looks like to do child-centred play therapy. They come in and they watch and then I say okay so now at home what I want you to do is practice doing some child-centred play therapy. I'll give them a quick instruction and that's actually called filial therapy - that's where you're having the parent actually use the basic principles of play therapy which is empathic listening, unconditional witnessing, no demands or expectations. Just being there with the child. That goes a very long way. So there's always stuff going on. If a child has an insight and they figure out when I feel this I do this I'll say you know sometime this week I'd love for you to share that information with your parents. See if you can teach them what you learned about that. So they might go home and try to teach that to their family. You definitely want to keep that translating back to the family as it's not just about what's happening in the play therapy office.
34:54 Where should families go if they want to find a therapist or to learn more about theraplay?
There is a website it's just www.theraplay.org
That's where all their materials are. There's a lot of beautiful resources. There's definitely a list of providers all across the United States and Internationally as well, so that's a great place to go.
In terms of general play therapy you can go to the association for play therapy. www.a4pt.org
Both of those websites have a tremendous amount of information and you know there's lots of people now really providing a lot of good help. A lot of parents don't like to sift through and read. That's why for me I like the personal component of it. I'd like people to come in and let me show them what I do. I sometimes invite Mums and Dads or carers to do a sand tray. I just say you can just look around and use as few or as many little objects as you want and just build a world in the sand. Most of the time they're just shocked at how much comes forward in that process. They're surprised personally, like wow this this tells me this and I thought I was way over that or whatever it may be. So again I just think the experience often is the most profound way to learn. The potential benefit of play therapy or any expressive therapies, dance, movement, music, drama, art, you know all of those are incredible and they seem to have something that resonates with kids a lot. As we keep growing up sometimes we forget that we do that too, so inviting adults back into play is often kind of a remarkable experience for them. One dad I saw was like six foot five and he made a picture. As he was leaving he said can you believe that I did something that beautiful? I didn't know I was such a good artist! He was just so full of pride. He didn't know he could do stuff like this and said I'm gonna try to do some more. So then the boy and the dad started doing scribble drawings together and you know we gave them all kinds of things they could actually do together. They had a blast and felt closer to each other. Sometimes people just need permission to do something.
37: 49 Is there anything else that you wanted to comment on or provide insight on today?
Safety and Connection
I think I've said most of what i think is important. I will just end with the notion that Doctor Stephen Porges says and that the safety is the treatment for the child. Everything that we do and how we orient about problem solving should include an element of how do we make the child feel safe. When the child feels safe you'll see it right away because their whole body changes. Their eye gaze changes, their full smile becomes more ample. But a lot of kids are walking around just in a body that doesn't feel safe to them yet. I think that's one of the most valuable contributions that Doctor Porges has made talking about just that whole sense of your body has some sort of an alarm system that tells you where it's safe and where it's dangerous. Unfortunately in kids with histories of trauma that alarm system kind of trips off more often than not because they haven't developed that secure attachment in order for them to feel safe. There's a huge connection between when kids start feeling securely attached and they can relax into themselves. They can feel more secure and more connected to someone else. The connection piece is really, really important. So important.
It makes sense logically.
Thank you so much your time today. I feel like I've personally learnt a lot from chatting to you and it's good to be reminded of those messages around it takes a long time and connection and regulation and patience.
It's a pleasure to be with you.
Thankyou.
To anyone making the time to listen to this recording by PCA Families, thankyou for giving up your valuable time for the benefit of the young people in your life.
Until next time have an amazing week.
PCA Families acknowledges the First Nations peoples of all Country throughout Australia. We are grateful for continued connections to lands, waters, seas and communities. We pay respect to Elders past and present as we express our intention to move together to a place of justice and partnership. We acknowledge sovereignty has never been ceded and Australia was, and always will be, Aboriginal lands.
PCA Families has a zero tolerance of child abuse and we are committed to establishing and maintaining child safe environments.
