SARAH: FOCUSING AND PLAY THERAPY WITH A SIX-YEAR-OLD CHILD
Sarah was six years old when her mother arid stepfather first brought her to me. Her apparent understanding of the purpose of therapy belied her petite body and high, piping voice: when I asked her if she had any problems, she replied that “Sometimes I go potty in my pants, I have bad dreams, and I feel sad because I miss my daddy.”
Sarah’s parents had divorced a little over two years before and the family had endured a difficult custody battle. Sarah now lived with her mother, sister, and stepfather, and apparently had good relationships with all of them. Nevertheless Sarah was displaying many symptoms of anxiety-she wet the bed, ‘played with herself’ a great deal, had a difficult time making decisions, and seemed to feel that she needed to be perfect. Most of all, she was reluctant to express negative feelings or anger. Sarah would be with her father, who lived out of state, for a long summer visit, and her mother was concerned that Sarah was too much of a ‘pleaser’ to defend herself against her father’s sometimes inappropriate behaviors.
I saw Sarah weekly for a total of twenty-nine sessions (every other week toward the end). As I reviewed my notes in preparation for this paper, I was quite surprised to find that we had had only four actual Focusing sessions. I had had the impression that there were many more, perhaps because these sessions were so pivotal in her therapy.
From the beginning, Sarah fluctuated in her ability to tolerate her more
difficult feelings. When Sarah first entered the playroom, she focused on a
poster of children displaying many different emotions. I asked her to point to a
picture “that you sometimes feel like,” and she pointed to a sad face,
saying “I felt sad when mommy and daddy got divorced.” When I asked her to
draw a picture of this, however, she drew a bright happy picture. Later she
willingly drew a picture of herself “sad because I miss my daddy” and
admitted that she was scared that “Mom and dad won’t figure things out.”
Finally, tired of all this emotion, Sarah asked to play, and we took out the
Play Doh. She played creatively, resourcefully, and with great energy, and I could see the health and vitality that existed side by side with her struggles.
During the next eight sessions, Sarah and I worked in individual play therapy. I soon realized that she was struggling with both angry, aggressive feelings, and a desire to be coddled and babied. She alternated between expressing these aggressive and regressive feelings, and retreating to the safer although highly creative artistic play that she so much enjoyed. One session she played with puppets, making them bite each other, then played with the doll house, unable to decide whether one of the dolls was a baby or an eight-year-old child. The next session, she spent the entire hour intently making multicolored candy and carefully wrapping it. At times Sarah seemed very invested in things that were cute and pretty. Her responses to story telling cards included “a very sweet and cute monkey, a cute little baby just waking up from its nap, and a really cute little puppy.” Immediately after this she produced a sand tray full of “pretty” flowers and trees, but made no mention of the warlike Indian and soldier who were facing each other in the center of the scene. Sarah’s true self seemed to be struggling
to break through her protective identity of a “cute little girl”, which was reinforced by nearly everyone who commented on how adorably petite she was.
During the next few weeks Sarah seemed to retreat slightly from dealing with her feelings. At home she seemed troubled and rather fragile, and the techniques I regularly use in therapy to elicit feelings from children were often ineffective. In retrospect, it seemed obvious that her troubled feelings probably had to do with an upcoming visit with her father. Sarah ended up enjoying her visit, and drew only bright, happy pictures about the things that she had done. But by the next session Sarah was again grappling with aggressive feelings-she made pretty little objects out of Play Doh, finished with a Play Doh man, and at the end of the session cheerfully smashed it with her fist, saying “You’re dead.” The next week Sarah’s mother reported that she had started to talk more about her feelings and seemed less frustrated. That week in therapy she continued the by-now familiar pattern of aggression followed by retreat; first she took a toy gun and shot every doll in the room, then sat down to cheerfully make a clay pizza.
The following week, the tenth session, I taught Sarah Focusing without prior planning. Sarah and her mother came in together and her mother explained that Sarah was very upset about being teased by a friend at school. I asked Sarah if she’d like me to show her something I sometimes did when I had a bad feeling that wouldn’t go away, and she readily agreed. I asked her if she could find the bad feeling inside, and she did this easily. Then I suggested that she listen and see if it had anything to tell her. “He didn’t mean it”, she said. Her demeanor changed immediately and she had no interest in any more talk; the issue was gone and she was ready to play. Something seemed freed-up inside, for Sarah began playing with clay in a much more animated fashion then she previously had. She talked about wanting to make it perfect. I thought maybe she was ready to deal with the issue of perfectionism, and I commented “That doesn’t happen very often does it?” She fervently answered “That’s for sure.” I asked how would it be if it was almost perfect; she replied “That would be really good”.
The next two sessions Sarah again absorbed herself in playing with clay, painting, and making a sand tray about a “pretty lady” on her way to see her husband. Then came a session that was critical in terms of Sarah’s use of Focusing to free up some of her stuck feelings. Sarah’s mother reported that Sarah had been clingy and tearful recently. “Sarah”, I said, “can you find that bad feeling inside you?”
“It’s hiding,” she replied after a moment.
I handed her a stuffed animal.” Can you see if it will hide in the teddy bear?” Sarah placed the bear next to her stomach and then up to her ear. I thought that she was just playing, staying away from the uncomfortable feelings, but in a moment she replied, “It’s about too many things happening”.
“Oh. Too many things happening. What are they?”
“I forgot,” she replied.
I reached over for a drawing pad and some magic markers ( always with me when I see a child). I drew a small person with a sad face, glanced at Sarah and began to sketch the pattern of her clothes. Intrigued, she grabbed the markers and began energetically coloring the person. (I have yet to see a child who is not intrigued by my drawing them, the more so because they are totally unintimidated by my primitive attempts!) I quickly drew six cloud shapes in a circle around the person and said” These are for all the things that are happening.” Something about the physical presence of spaces to be filled
The following week we had another crucial Focusing session. Sarah had been in a bad mood all afternoon but said that she did not want to talk about it. “Sarah,” I said, “you can let the feeling talk just to you; you don’t have to tell me and your mother if you don’t want to. How about that?”
“Okay,” she answered. She was quiet for a minute, then pointed to her stomach.
“What does it feel like?” I asked.
“Jumpy and angry; it’s mad and it doesn’t want to talk to anyone.”
“Can you try being very nice and friendly to it?”
“No! I’m mad at it.”
I suggested to Sarah that she had plenty of room inside to have both feelings and that the jumpy, angry feeling probably had a good reason for feeling that way.
“It sure does! People have been bugging me and pushing me on the playground all day!” After a pause of a few seconds she said in a tone of excited discovery, “I think part of the reason I’m so mad is that I didn’t get to say good-bye to mom in the morning.” Turning to her mother, she said,” You were already asleep and daddy said not to wake you.” Sarah’s mother was understanding about this and said that maybe they could tell daddy that it was okay for Sarah to come in and say good-bye in the morning. After this Sarah insisted that her mother come to the play room with us, where she engaged in more witch-stomping. Later Sarah’s mother reported that during the next week, Sarah had continued expressing anger more frequently.
During the next few sessions, things seemed to be winding down. Sarah had few difficulties to report and she was wetting herself less often at night. We decided to hold sessions only every other week. During the twenty-seventh session, Sarah’s mother reported that Sarah had become in touch with a three-year-old child inside herself and that this three-year-old was much angrier and sadder than Sarah herself. At the next session, Sarah reported that when she was playing a game with her family, her three-year-old was sad that she wasn’t winning. Sarah had talked to the three-year-old and told her ‘I know you feel sad, but maybe you’ll win the next game”. Then she felt better. The three year old also wet the bed whenever Sarah took off her “good-nights” (absorbent underwear for bed-wetting). When I suggested that Sarah ask the three-year-old what she could do to help, the three-year-old said that she was scared and that Sarah couldn’t help her. “What would you like to say to your three-year-old now?” I asked. Sarah told her that she felt sad and wanted her to stop. The three-year-old replied that she would try, and Sarah was satisfied. At this point I felt that Sarah, with the assistance of her mother, was becoming her own therapist, and no longer needed me. We decided that the next session would be our last. During the last session Sarah drew me a wonderful good-bye picture with a caption that was straightforward, cheerful, and unapologetic-a style that seemed to be becoming her own.
When play therapy works, I am frequently at a loss to explain exactly why it was successful. There is rarely a direct, observable relationship between events in the play therapy and changes in the child. In the case of Sarah, the power of Focusing was no more directly explicable. There were only four Focusing sessions; in only two of these sessions did Sarah experience a “shift”; in none of the sessions did she deal directly with her ambivalence about aggression and anger or about regression versus growth. Nevertheless, each of these sessions seemed to be an important turning point in the therapy; each followed by perceptible behavioral changes. What follows, therefore, is a group of loose hypotheses concerning the power of Focusing in children.
1. It is important to note that, in spite of her troubled feelings, Sarah was in many ways a sophisticated and well-functioning child, relatively at home in the world of feelings It was crucial, too, that she had a very supportive parent, willingly to not only accept all of her feelings, but also to make adjustments in her schedule to help meet Sarah’s needs. This kind of concrete receptivity to a child’s needs is, I believe, enormously helpful in allowing the child to be more receptive to his or her own feelings. Focusing always involves the creation of a friendly supportive “other” inside; with children it seems very important that there also be a friendly “other” outside in their day-to-day lives. Although I have used bits and pieces of Focusing in therapy with children less friendly with feelings, it is rare for me to find a child with whom Focusing can become a major modality. My experience is that troubled children simply do not have the anxiety tolerance to sit with something really difficult, or even to listen to suggestions on how to be gentle with it. The lives of these children seem to be so tilled with difficult feelings that they dare not attend to them or they would be completely overwhelmed; because they experience their outside world as unsafe, they do not have a safe place inside. Helping these children find or create such a place would be a crucial first step in their therapy if Focusing is to be used. I have recently experimented with teaching whole families a “safe place” exercise and thus far the response has been very positive; it remains to be seen if this can serve as a transition to Focusing.
2. For Sarah it seemed important to be able to fully express her anger against herself It was only after refusing to be friendly to her upsetting feelings, and expressing her anger at these feelings, that she was able to listen to them in an open way and learn what was under them. I am coming to believe that the expression of anger against the self can be a crucial part of freeing up aggressive feelings in individuals of all ages. It may be that expressing this anger at the part of the self that is problematic, can help prevent this anger from turning into entrenched self-hatred. Perhaps we need to be especially careful that, when we work to create a friendly hearing for feelings, we also create space for this type of anger.
3. Focusing for Sarah, as for adults, seems to free up energy in a way that is not directly related to content. It is as if the energy released by “unsticking” an area of feeling becomes available to use in many ways, and that many different kinds of feelings also become unstuck in the process. This seemed to be the case, especially, following the session in which Sarah worked on her “nervous” feelings about a friend encouraging wrong behavior. Although that session did not even deal with issues of anger or assertion, it was followed by a burst of more freely assertive and expressive behavior. That session also illustrated the next point.
4.Shifts appear unnecessary for Focusing to perform its magic. I believe the
experience of major shift
is important both for the insight and relief that it brings, and for the enormous feeling of empowerment that comes from being able to solve one’s own difficulties from inside. But there is also a great deal of empowerment that comes from the process of simply taking charge of one’s feelings, in the sense of not being a victim-sorting through, putting this here, and that there, listening to this now, and that later, and simply acknowledging a feeling as unmanageable for the moment but definitely not forever. Children often have so little power in their daily lives; to discover a powerful stance toward their own feelings must be enormously self-enhancing.
Very little modification of technique seems necessary to focus with verbal children above the age of six years old. I very frequently use clearing a space, not in the sense of actually clearing problems from the body (although I do this with older children), but simply to raise issues and for the relief of naming things. I don’t know whether or not the drawings are necessary, but they certainly engage the attention of the child who is resistant to talking about bad feelings. I keep my language simple, usually limiting directions to “Find the place inside where you feel it,” and “See what that feeling wants to say to you.” From that point on., creativity and ingenuity may be required. The game of projecting the feeling into a toy or stuffed animal often seems effective. I believe this is because it allows the child to take on the power and security of being the bigger, nurturing, caring presence. This, in turn, allows the child to take on the Focusing attitude of being separate from, but in caring relationship to her feelings. In this regard, children are no different from adults: it is this relationship that makes healing possible.