28. Play Therapy for School-Aged Children with Anxiety with Brittany Dyer, LPC-MHSP

Today’s special is my good friend, Brittany Dyer, a  Licensed Professional Counselor.  Brittany shares her knowledge and expertise in play therapy.  

• How does anxiety present in school-aged children? 
• How does childhood anxiety present differently from adult anxiety?
• Behaviors that may indicate a child has anxiety
• Anxious parents with anxious children.
• Things parents can do to help their child with anxiety.
• What is play therapy? How does it work?
• How to introduce therapy to your kids
• How does play therapy reduce anxiety in children and even in adults?
• Signs that your child may need a therapist 

Brittany Dyer, LPC-MHSP

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Transcript of Episode 28

Hope for Anxiety and OCD episode 28. Today on the show, I got to talk with a good friend, Brittany Dyer about play therapy. If you remember from one of our original episodes back in the beginning, we talked with Anika Mullen about PCIT and how anxiety shows up in young preschool-age children. Today with Brittany, we’re going to be talking about how anxiety shows up in school-age children, and how play therapy is able to help with that and develop kids’ confidence.

Carrie: Tell us a little bit about yourself. 

Brittany: My name is Brittney and I am a licensed professional counselor and I am working towards getting my registered play therapy certification. I have an amazing supervisor, Jamie Langley. She is the president of the Tennessee Association for Play Therapy. We have an awesome supervision group that we meet once a month.

So I’m really excited about that. And I have a private practice in Smyrna, Tennessee, and I’m just across the street from Carrie.

Carrie: Which is fun. 

Brittany: Yeah. I have been back in private practice for a little over three years now. I took a little sabbatical. My husband and I lived overseas. We were missionaries in Haiti and in Thailand for a couple of years. And before that, I had been in private practice probably three or four years before that too. So we really enjoyed our time learning about other cultures. I feel like that really helps me in the counseling field as well, knowing about other cultures. Glad to be back here now and doing what I love, counseling and especially working with kids.

Carrie: There’s a wide variety, I guess of training that people can get in play therapy. Some people may say that they use play therapy and some people may say, “I’m in the process of becoming a registered play therapist” and that takes a while. Can you tell people a little bit about what that process is like?

Brittany: Yeah. So they actually have just changed the rules and I’m not a hundred percent up on them as I’m still working towards it. I just keep trying to knock things out. To become a registered play therapist, you do have to have a mixture of play therapy training. Like education we call them CEUs. You have to get a large amount of those. They have just increased those. You have to have a certain amount of hours of supervision with a registered play therapist who has the supervision certification as well. And then you have to get quite a bit of client hours as well.

Carrie: So people know this is on top of what you’ve already done to become a licensed professional counselor. So it’s like it’s another certification process of all, after graduate school, after licensure stuff. It’s quite a process, but it’s good. It sounds like a good process for people who know that they really, really want to do play therapy.

And that’s kind of like their niche and I think it’s interesting when people are looking for therapists to kind of know some of these differences, because they may see certain letters after people’s names and not necessarily know what all of that means. Or some counselors may say, I have training in this area, but they haven’t done the further study or the further continuing education to get certified or so forth. That’s a good process. 

We’re going to talk today a little bit about anxiety in school-based children. I had a guest on the show in one of the pretty early episodes who talked about anxiety in toddler preschool type ages. And so since anxiety looks different, a little bit different at different ages.

Tell us kind of how it presents in school-aged children.

Brittany: Anxiety looks different than it does with adults. Just a few things I guess to look for children that would be different than adults would maybe be like a clinginess to their parents or to another adult, to their teacher or anything like that because they’re looking for that security.

So clinginess would be one. Another thing would be irritability, a high level of irritability. So tantrums, throwing fits those sorts of things that parents really get irritated with. It’s not just a fit that they’re throwing it if they’re having a high level of irritability because maybe they’re feeling anxious about something.

And another thing would be lots of unexplained stomachaches or trying to avoid going to school. Those sorts of things would be signs to look for in children that would be different than adults. 

Carrie: Right and I think it’s easy for people to mistake defiant behavior just as my child’s having behavior problems versus really trying to dig in there and understand why they are refusing to do things. What’s underneath that? What’s driving that behavior?

So that’s a good thing for their parents to kind of be aware of. And also I’m sure that you find a lot of times that children who are more anxious have a tendency or a greater proclivity to having an anxious parent possibly. So the parent is dealing with some of their own anxiety and then the child’s dealing with their anxiety. And sometimes those two things can interact with each other in a healthy or unhealthy way.

Brittany: Yeah, absolutely, definitely. Not only is it biologically related, that maybe a child can have anxiety because their parents could have anxiety, but it could also be a learned behavior and environmental behavior because they’ve seen their parents acting in an anxious way.

And so then they begin to kind of display those symptoms as well. And they may be acting out in an anxious way as well, but again it can look different in the parent and the child. 

Carrie: I’ve noticed just from my work in the past, I don’t work with that many children now, but I did in the past.

This tendency for there’s great empathy for that child who’s anxious if a parent has experienced anxiety and there may be a tendency to kind of want to give in a little bit more to the avoidance, or just allow them to not do things that would be healthy or good for them to do. 

Brittany: Yeah. That can absolutely happen. Not that that’s necessarily a helpful thing but it can happen. 

Carrie: Yeah. How do you work with parents who maybe are experiencing some of that and having a hard time? Maybe encouraging their kids to do what we call brave behaviors? 

Brittany: Well, one of the things that I work with parents with is number one, recognizing if you have anxiety and the way that you portray your anxiety in front of your child.

So if you have anxiety and you’re acting out your anxiety in front of them, they’re going to pick up on that like we were talking about and they’re going to begin to exhibit those symptoms as well. That’s one thing is making them aware, but also kind of helping them learn how to not show those maybe in front of their kids so that they aren’t picking up on that. And that’s not something that they’re doing. Another thing that I would say would be to kind of teach them how to encourage their children to have those brave behaviors like you’re talking about. Encourage them to try things even when they’re hard. Kind of taking on that sort of a language like, “yeah, you can still do it. It might be hard. You can try. You don’t have to succeed. It’s okay to fail.” 

So again, talking with parents about those perfectionistic tendencies that a lot of these kids pick up on. Because that’s what we are as parents. A lot of times we portray them too. So talking a lot about those perfectionistic tendencies and helping them to kind of let’s reel those back a little bit and not project those onto our children so that they can just do the things that are normal for them to do and not expecting behaviors that aren’t normal for them to do.

Carrie: Right, because they’re not going to get it right all the time. We don’t get it right all the time either. Let’s talk a little bit about play therapy. How does that work? 

Brittany: The way that we in the play therapy field kind of describe it is that play is a child’s language. They may not have the language to verbally tell us everything that they’re experiencing. So we use play to be their language. Play provides them a safe place to express themselves because they may not have the language. Sometimes we as adults don’t have the language either because it’s hard to get down in that deep stuff that we’re going through but play is a safe way to be able to do that.

We can play out our emotions in a positive way. A child doesn’t necessarily come in and pick up a doll and say, “this is me.” And these are all the things that I’m experiencing. It doesn’t happen that way. They can choose different kinds of toys that symbolize what they’re going through and play that out in a more positive way, not necessarily in a way that we would sit down and talk about it as adults. It also helps them to work through their emotions and to learn how to regulate their emotions themselves, which also helps to boost their self-esteem. So if they’re working through their issues on their own, they’re figuring out how to do them, which again builds their self-esteem to say things like, “Hey, I can do this. I can handle this. I’ve done this on my own.”

And then it gives them a place to practice the skills that they learn while they’re in play therapy. We practice those skills over and over again as they’re playing. We do those in a fun way. We may use bubbles to do breathing exercises so that they can learn how to blow bubbles. Because if you blow a bubble quick and fast, you’re either going to get little ones or you’re not going to get one at all, but if you take a slow, deep breath like we teach people to do to help them to calm down then they are going to be able to blow a really big bubble, which is always fun. Then pop the bubbles, which is a release too. You’re having fun and you’re doing these things. There’s a lot of different skills that you can use while having fun but also teaching them different coping skills and things like that. Basically, play helps us to learn how to express what we’re feeling.

It helps us to learn those physical skills like coping skills. It also helps us, helps kids through touch, which is also a big thing with kids, 

Carrie: Sensory issues or things like that. 

Brittany: Yeah and then also emotionally just helping them to work through whatever issue it is that they’re dealing with.

Carrie: Do you find that some kids that are anxious maybe it’s almost like they don’t know how to play? They’re so serious or afraid of getting something wrong or anxious about engaging, maybe with different materials or trying new things that play process does kind of help loosen them up a little bit or be more open.

Brittany: Yeah, so sometimes it happens when I first come into the room. It takes them a while to kind of get used to the room and get used to what they can do and what they can’t do and can not be messy, those sorts of things. But as time goes on and they begin to see that they’re kind of in charge of how things go with boundaries obviously. I don’t want anybody to get hurt, but, but they’re kind of in control that they can. They begin to relax and they begin to play.  And then they begin to work through the things that they need to work through, which is part of that anxiety, and whether it’s perfectionism or just being worried about what other people think of them or whatever it is they begin to. We’ll work through those things.

Carrie: Socialization, I think can be a big aspect of those kids that are anxious about being in social settings that can help them too as they are interacting with you. I think it’s important for parents who are really thinking about bringing their kids in for therapy to recognize that it is going to look a lot different than if the parent went to therapy themselves. I think sometimes parents may unintentionally put this pressure on their child like, “you need to go in there and you didn’t tell Miss Brittany everything that’s going on with you, everything that’s bothering you.” And that they’re not able to do that as an unrealistic expectation a lot of times.

Brittany: Yeah, it’s definitely a learning curve when I explain to parents what we do in here. And I tell parents a lot of times, I’ll say you’re Tom may leave here and be like, “Oh, we did that. It was play.” And I’m like, “I promise that’s not all we did experience, but we worked on some things too while we’re in here.”

If you’re engaging with a child where they’re in control and you’re reflecting what they’re doing and you’re listening to them, change is going to happen because again, they’re able to just work through whatever issues that they’re dealing with.

Carrie: And I would hope that it should be an enjoyable experience for them because otherwise, they won’t want to come back. Right. There’ll be like kicking and screaming like, “Oh, I don’t want to go there.” Also, don’t tell your kid that they’re going to a doctor because that really sometimes can freak them out or make them think that they’re going to get a shot or have other kind of nervous expectations about what to expect.

Brittany: Yeah, I think that’s a good thing. As best as you can explain what they’re going to be experiencing while they’re there, but I try to do that when I meet with them to explain to them. And when they come in and they see the toys and you can tell they’re kind of shy and they’re like, “Can I play with the toys?”

I’m like “of course.” So again, trying to explain that. In my room obviously looks different than if you go to a doctor’s office and you sit there. On the table, there’s nothing to play with in there. It is a lot different, but I always encourage parents. I have this question sometimes, do I tell them that they’re coming to see you? How much do I tell them? And I say, tell them as much as you can so that again, they’re not anxious about coming in and worried about what the experience is going to be like. 

Carrie: Yeah. I think anytime we can prepare kids and let them know what’s coming and help them set up for success, I think that’s going to be really awesome.

So tell us a little bit about the ages maybe that play therapy is typically utilized for and what an initial first session might look like. 

Brittany: Play therapy can be used for all ages. Like I said, sometimes we have difficulty as adults expressing everything that’s going on. So play therapy can be used with adults, but play therapy is most appropriate for children ages three to 12.

I use aspects of play therapy with kids up to 18. And sometimes we use art therapy with adults too. And that would be kind of considered in the play therapy realm as well. But it’s mostly used with children ages 3 to 12 and that just allows for that age group where they’re more willing to play a lot of times. When you get 13, 14 and those teenage years are kind of like, you think that you shouldn’t, that’s kind of like the societal perception and so they don’t as much. They’re like, “I don’t really want to do that,” but it still can work for them too. 

Carrie: I know that I’ve also had adults in the office that had maybe very rigid childhoods where they didn’t get that opportunity to play or didn’t get the opportunity to express themselves and doing things like playing with Play-Doh or blowing bubbles.

Sometimes it’s a little uncomfortable for them, but it allows them to relax and be a little bit more free. So that’s true. There are elements certainly that can be used with all ages. What is the first session of play therapy usually like?

Brittany: Typically during a first session of play therapy, my initial session I asked parents to come in so that I can get that background information from them [00:18:44] and I can explain what play therapy is kind of what they should expect. And then I discuss with the parents what their reasons are for bringing the child in. What symptoms they’re experiencing and have been noticing.Things that exacerbate their symptoms and things that might help with their symptoms as well.

And what the things are that they’re noticing. So we discuss all of those things, as well as a medical history, family history, the development of the child just so I can get all of that background information to know, are there reasons why the child may be acting this way? What’s going on in the child’s life that may be kind of causing them to exhibit these symptoms, but also to know. When they’re playing, they’re not going to tell me exactly what’s going on. So I kind of need a background to know. If they’re playing with animals in a certain way, why are they kind of playing with them in that way?

So just getting all of that background information is for me to kind of know how to proceed and know what’s going on. And I typically like to meet the child during this first session if the parents want to talk to me individually without their child being there. That’s perfectly fine. But if I can meet the child on that session then that kind of gives us a leg up where they can come in.

They’ve already met me. They’ve seen the room and they know what to expect. When a child comes in for the first time, they come into the room, and most of the time they just kind of look around and kind of see what all’s in here and figure out what they can do. What their boundaries are I guess you can say, which are very limited unless they’re going to get hurt.

There aren’t very many boundaries because again, I want them to feel in control so that they can work through the issues that they’re dealing with themselves. So they come in usually and kind of figure out what they’re supposed to be doing because it is a little different. I mean, you don’t go into a doctor’s office and just sit down and play, that’s different.

So they kind of try to figure out what they do while their parents are waiting in the waiting room. If they want their parents to come back with them the first time or the first couple of times and that’s fine, they can do that. Usually what happens is the parents will come in and the parents will try to retreat out the door throughout the session.

Just so that, I mean, if a parent brings their child to counseling or to play therapy, then that there’s a reason and they want them to be able to be there. And then usually by the end of the first session, not always, but usually they become more acquainted with the room. They become more comfortable.

They become more comfortable with me and they begin to play. Again, not always, but they may begin to play and just figure out what I am supposed to do while I’m here. So even in the first session, you can kind of see that the anxiety decreases a little bit, just because “Okay, I can choose what I want to do. I figured out what I can do in here.” 

Carrie: Good. How have you seen play therapy be helpful for children with anxiety? 

Brittany: Just allowing a child to make their own decisions in the playroom really gives them a sense of power and control over things. Children don’t often get control over things in their lives because there’s always somebody telling them what to do. You have parents and you have teachers and those are good things. Children need people telling them what to do for an hour or 30 minutes to an hour. They get to come in here and they get to be in control and they get to decide what they want to do.

So that just helps them to just kind of take on that sense of power for themselves and be able to make things go the way that they want themselves to go. And that in and of itself reduces anxiety.

Carrie: That builds a level of self-confidence and mastery. 

Brittany: Yeah. And there’s also no judgment in my room if whatever they do is okay. And so that also builds that sense of self-confidence that, you know, if I do something bad, no one’s going to reprimand me for it. Now, if you’re going to do something that’s going to get you hurt. Then I’m going to set a boundary for you, but I’m not going to reprimand you for it.

You’re not going to get in trouble for it, but you’re going to see that that’s not inappropriate behavior. So even that just gives them that sense of self-esteem that’s building within them just to come to a place where they’re not being judged. And then that allows them to see themselves as good.

“I am a good person.” And so when we have that nonjudgmental attitude and we have lack of reprimand but teaching opportunities then children don’t really need to worry because they don’t have those things to worry about. I’m not worried if I’m going to get in trouble, I’m not worried about what this person’s going to think of me.

So those things help to reduce that anxiety with them too. 

Carrie: Right. Just a difference between if you are in a play therapy session and they grab the toy gun and start shooting all the stuffed animals. Probably most parents would be horrified. Whereas the play therapist is really thinking about what is this child trying to communicate to me by shooting all the stuffed animals.

You know, it’s just a random example.

Brittany: It’s not necessarily about the child shooting. And we would think about it. Maybe he’s trying to kill the animals.  There’s lots of different interpretations. It could be going on but it’s not quite as literal as we typically think about it.

Carrie: Yeah. Sure. Just finding different ways to kind of like, I’m sure as you’ve gone through your training too, the emotions that are coming out and the scenarios that are playing out, a lot of times kids will act out things that are going on in their families or at school with other children. If they have bullying issues or things like that.

And it’s, it’s been really interesting to see and sometimes you may walk away and not totally know that they worked through something, but not totally understand what it’s about until the parent comes back to you the next time. And they say, “oh, they seemed more comfortable on the playground when I took them to the park or they’re sleeping in their own bed now.”

So it’s a little bit harder, I think, maybe to measure some of the results, but you’re really just looking at what’s going on in their day-to-day interactions. 

Brittany: Yeah. Sometimes it definitely is hard to measure. And it’s not really our job as play therapists to understand everything that’s going on in their life, because again, it’s about them working through it. We don’t have to know exactly everything that they’re working through, but knowing that the space that’s provided for them to work through it, they’re going to do that. And I guess the results would be the parents come back later and say, “Hey, so-and-so has been really behaving well at school, which is really different than in the past.”

And you may not know exactly what happened to help them do that but the result is that their behavior has changed. 

Carrie: Yeah. That’s pretty awesome. I know that we’re talking specifically about anxiety but play therapy can actually be used for a wide variety of issues and behaviors that may result in children. Do you want to talk a little bit about that? And just kind of like expand out the window a little bit.

Brittany: Play therapy can be used for a number of different issues that children are experiencing. It can be helpful for children with depression. It can be helpful with children who are experiencing sexual abuse or physical abuse. It can be helpful for children who have been neglected, children who have been removed from their homes. It helps children with autism. It helps children who have low self-esteem. It really is beneficial across the board for any psychiatric problem that children are experiencing, ADHD as well. 

Carrie: Good. I think that’s helpful for parents to know.

Is there anything that you want to talk about in terms of, if there’s a parent that’s kind of on defense, maybe like, I’m not really sure if my child needs therapy or not, how would you help them know? When is a good time to bring their child in?

Brittany: So typically a good rule of thumb to go by is if their typical daily life is being altered by anything, whether that be anxiety, again, stomach aches, they don’t want to go to school headaches, things like that. If their daily life is being altered, then I would suggest contacting a professional.  And even just calling it professional, most of them are very helpful. And if you just have a question, should I bring my child in or should I not?

I say that anything is affecting them. Maybe they’re not sleeping well. Maybe their grades have dropped. Just different factors like that. Those things seem to be different than the way that they typically have been in the past. 

Carrie: Good. And I don’t think it hurts to potentially establish care with a provider and have them maybe evaluate your child for a few sessions, and then they can make a recommendation about whether or not they feel like further therapy would be helpful, or if it seems like the child is doing well in spite of maybe circumstances or changes that have happened in their life.

Sometimes parents when they go through things like divorce or major family changes or death, sometimes the kids bounce back and are very resilient and do well. But the parents were just a little bit more concerned maybe about, “I don’t know how this is going to affect them.” So I think looking at their day-to-day functioning level is a really good gauge.

As we’re winding down to the end of the episode here, I like to ask our guests to share a story of hope, which is a time where you received hope from God or another person. 

Brittany: My story actually kind of relates to what we’ve been talking about today and why I wanted to become a counselor. I lost my parents when I was in elementary school. They died suddenly. And I had a school counselor who was amazing, her name’s Jana Chambers. Thankfully, I can still be in contact with her. My husband and her son are really good friends. So I still get to see her sometimes which is amazing. She was my hope during that time. She really helped me. I don’t remember anything that we did, to be honest. I don’t remember. I remember we played, but I don’t remember anything specific. The only thing I remember is one time we had puppets out and that’s all I remember, but just going to see her and having that space where I felt comfortable and she was just such a comforting person and caring and listening.

I just remember feeling so light when I would come back from her office. That’s the only way I know how to put it. I felt light. She helped me so much and gave me so much hope for my future in such a hard time for me. So I am just so thankful for her and all the children that she influenced and helped throughout the years.

So I’m thankful that she inspired me to be a counselor and that I just get to pass along that hope to many other kids too. 

Carrie: That’s really awesome. That was something I didn’t know about you. And that’s a great story. Thanks so much for coming on and sharing your wisdom with us about kids and anxiety and play therapy. I think this is a great conversation for people to learn from. 

Brittany: Yeah, of course. Thanks so much for having me. 

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Just a reminder that this Saturday, the 15th at 10:00 AM Central time, I will be hosting a free webinar called Lightening the load, Reducing Shame for Christians. We’re going to be talking about the differences between guilt and shame, condemnation.  How to get out of shame and condemnation and get into a healthier relationship with God. It’s going to be about an hour. And I really hope that you’ll be able to join us. For more information please go to www.hopeforanxietyandOCD/webinar to sign up. 

I received a very sweet message from Will the other day who said that the podcast gives him hope.

That really meant a lot to me because I can look at the download numbers for the podcast. I can look at where people are listening from, but it’s always so nice to be reminded that you are each individual with unique needs and desires and experiences that you’re having. And so to hear from you on an individual level really means a lot, and it helps encourage me to keep going and keep doing what I’m doing.

Thank you so much for all of your feedback, love and support in this process.

Hope for anxiety and OCD is a production of By The Well Counseling in Smyrna, Tennessee. Our original music is by Brandon Mangrum and audio editing is completed by Benjamin Bynam.

 Until next time may be comforted by God’s great love for you.