Written by Cathi Spooner, LCSW, RPT-S

Image by serrano1004 from Pixabay

How can therapists create a sense of safety within the treatment process for children and teens using parents and the therapeutic powers of play? For me, as a therapist and as a supervisor, this is a critical question that needs to be considered by mental health professionals working with children and adolescents. Children and teens need to use their parents to help them deal with stressful events and situations since challenges are part of life. How children and teens use their parents for emotion regulation support varies depending on the developmental needs of the child and the quality of their attachment relationship with their parents. Different developmental stages require different responses from parents to help their children learn to internalize coping skills and regulate their emotions during stressful events throughout their life journey. Children in higher acuity family systems will typically experience more negative attachment experiences than children in lower acuity family systems. For clarification, the term parents when used in this article refers to any adult who is the caretaker for a child or adolescent, such as a parent, grandparent, aunt or uncle, and foster parent.

This article discusses the importance of helping parents facilitate the activation of their child’s social engagement system to create a sense of safety for effective co-regulation, which means deactivating the neuroception circuits (Porges, 2011) in their child. Neuroception is a term coined by Stephen Porges (2011) as conceptualized in his Polyvagal theory.

First, a little “nerding out” on neurobiology and safety. Hang in there with me. Polyvagal theory helps us understand how our body responds to threat in order to ensure our survival. It’s based on the theory that our autonomic nervous system (ANS) is composed of three structures in an evolutionary hierarchy from primitive to more advanced and only present in mammals. The ANS is involved with the body’s automatic internal regulation of physiology such as the regulation of heart rate, lungs, digestion, and is connected with the cranial nerves involved with hearing, sight, and mouth. The ANS is composed of the sympathetic nervous system (SNS) and the parasympathetic system (PNS). Polyvagal theory postulates that the parasympathetic system, which is responsible for immobilization or slowing down autonomic system functions (aka the ANS “brakes”) is composed of two parts, dorsal and ventral vagal nerve systems (Dana, 2020, Porges, 2011). The most primitive system in the ANS is the dorsal vagal nerve system which is present in reptiles from an evolutionary standpoint. Next in the ANS evolutionary process is the sympathetic system that allows for activation of bodily functions to support the fight-flight response. The most advanced system is unique to mammals and allows for social engagement and connection via the ventral vagus nerve system. The vagus nerve is a system of nerves that are spread throughout the body with two main components, the ventral (most advanced and myelinated) and the dorsal (most primitive and unmyelinated).  

So, what are the neuroception circuits as conceptualized by Stephen Porges (2011) in his Polyvagal theory? Neuroception circuits are the neural systems that are constantly assessing threat without our conscious awareness. They are designed to keep us alive and alert to a potential threat. These neural circuits are designed to assess safety first and foremost, so they need to be deactivated before the neural circuits of the social engagement systems can be activated. Essentially, our mind needs to determine that there is no threat present before we can “let down our guard” and engage in social interaction in a relaxed and trusting manner.  This includes the ability to engage in playful activities. We need to feel safe before we can fully engage in play and be playful. If you’ve ever been around children playing, especially boys (I’m a mother of boys and grew up with two younger brothers), you’ll recognize that fun, playful engagement can instantly change once one of the children perceives the behavior of another child as threatening.  The dynamic can change quickly.

So how is this relevant for children and their parents? Hang in there, I’m going to “nerd out” a bit more – this time about attachment and neurobiology. Children begin forming their conceptualization of relationships from birth based on early experiences with their caregivers.  Bowlby (Marrone, 2014) referred to this understanding of attachment relationships as internal working models. Fonagy and his colleagues (Fonagy, Steele, Steele, Moran, & Higgitt, 1991) refer to the concept of mentalization (also known as reflective functioning) as the way in which our mind makes sense of ourselves, other people, and our relationships with others and is heavily reliant upon early parental experiences. I tend to view internal working models as another way to comprehend mentalization. The neurobiology underlying mentalization, and our internal working models, is heavily influenced by our early experiences and becomes encoded with our early memory and our emotions, perceptions, and experience of events and interactions with others. Mentalization then becomes the foundation for the way in which we form our sense of self, our “place” in the world, and our relationships with others.

Siegel (2011) refers to interpersonal neurobiology as the way in which our mind, through the flow of energy and information via our neural circuitry, creates “maps” for understanding ourselves and others. The mentalization process contributes to the creation of “Me” maps, “You” maps, and “We” maps. These “maps” help us to navigate a complex social world and relationships.

Okay – so now I’m going to bring it all together. Children are reliant upon the adults in their lives to help them survive and grow in the world. Our ability to use the adults in our lives is greatly influenced by our experiences of relationships, especially with early caregivers. Our ability to feel safe within our intimate relationships allows us to use those relationships to manage stressors and navigate challenging situations. Children are heavily reliant upon parents for survival and co-regulation and need to heal within the context of these intimate relationships.

Engaging parents in the play therapy process facilitates the ability for children to use their parents as “safety people.” There are a variety of ways to engage parents in the play therapy process, which will likely depend heavily on the acuity level of the family system and parents. A low acuity family system will have parents who are attuned to their child and the needs of their child. These parents have well-functioning social and emotional capabilities to be adept at the give and take aspects of relationships and the ability to regulate their emotions well overall. Children in these families tend to have an easier time using their parents to help them establish a sense of safety.

Keep in mind that the acuity level operates on a continuum from low to high. Higher acuity families tend to have less attuned parents, family histories of addiction and/or trauma, and significant mental health issues. Therapists need to assess the acuity level of the families to figure out the most effective ways to engage parents in the treatment process, and help their child use their parents as their “safety people.” Helping even higher acuity parents develop the ability to create safety within their parent-child relationship will help children use their parents more effectively to deal with life’s challenges. After all, children will spend the rest of their lives with their family and will be with their therapists for only a short time of their life. It’s imperative as therapists to help parents and their children develop a stronger attachment relationship because the long-term positive treatment outcomes are greatly improved when parents are able to be successfully integrated into the treatment process.

Therapists can use the therapeutic powers of play with children and their parents as an avenue to create that bridge toward safety and healing. Remember, the ability to engage in play requires that the neuroception circuits are deactivated so that the social engagement system can be activated for play to occur. Using the therapeutic powers of play can help to engage children more effectively because the “language” of children is play. Even adolescents, especially socially immature adolescents, can engage in playful exchanges with their parents. They can use the therapeutic powers of play via expressive arts to communicate and explore their self-concept and relationships in a way that is less psychologically threatening to them.

Here’s a recap:

  • Neuroception circuits need to be deactivated before the social engagement system can be activated. We cannot engage in trusting social interactions unless our threat systems are turned off.
  • Children’s experiences with the adults in their lives will influence their understanding of relationships and the ability to use their parents as “safety people.”
  • Helping parents more effectively engage in the treatment process allows the ability for children to use their parents as “safety people” throughout their lifetime.

 

Are you a mental health professional working with children, youth, and families using play therapy and expressive arts? Check out this free pdf for the Be 5 Framework using intention and therapeutic presence within a clinic framework for play therapy.  Click here

 

References

Dana, D. (2020). Polyvagal exercises for safety and connection: 50 client-centered practices. New York, NY: W. W. Norton.

Fonagy, P., Steele, M., Steele, H., Moran, G. S., and Higgitt, A. C. (1991). The capacity for understanding mental states: The reflective self in parent and child and its significance for security of attachment. Infant Mental Health Journal, 12(3), 201-218.

Marrone, M. (2014). Attachment and interaction: From Bowlby to current clinical theory and practice (2nd ed.). London, UK: Jessica Kingsley Publishers.

Porges, S. W. (2011). The polyvagal theory: Neurophysiological foundations of emotions, attachment, communication, self-regulation. New York, NY: W. W. Norton.

Siegel, D. J. (2011). Mindsight: The new science of personal transformation. New York, NY: Bantam.