3.) KP: It sounds like a very versatile approach where you are helping the client connect with themselves on multiple levels and through different pathways – not only through the mind, but also through the body. 

Since some people may not be familiar with how doing some drawing work, theater, or using the sand tray might be useful when coming to therapy.  Could you describe a typical scenario where you may lead the client to do something more in the creative arts?

Janice:  Well, with adults, I rarely start with the sand tray (laughter).  Some adults later in the process, love working with the sand tray to access their more innocent unconscious inner child. Very often with a child, the first session will begin with the sand tray.  Children are often attracted to the small figures, and enjoy the soft grains of the sand.

A sand tray is comprised of soft sand in a wooden box, and shelves of various small toys, including, figurines, animals, houses, trees, furniture, teepees, mythical figures and natural objects; shells, crystals and stones.  The client, most often a child, is encouraged to choose objects and arrange them in the sand. After a few objects have been placed, and a certain level of attunement is reached between the child and myself, I ask the child to tell a story about the objects. The sand tray is a projective technique, which approached with curiosity and spaciousness, allows the child to begin to share their inner world.

With time, we’ll explore the figures they choose, and what they represent. For example I might ask, “What figure is you?  Which is your little brother?  Which is your mother or father?  “What is the crystal?  Much is learned from exclusion, as much as inclusion, in the sand tray.  Sometimes we will transform the sand tray into a role-play, where the child and myself will act out the different characters and objects, from the sand tray in the studio.  Sometimes children get very involved, asking me to say certain things, and act a certain way, and have them respond.

Children like that I am so willing to embody and take on a dramatic role, and even exaggerate for effect.  Children like humor, and enjoy that an adult is willing to play. This approach on my part, encourages children to express their feelings, and be freer in their bodies. I will always watch how the child reacts, and modulate my response in relationship to theirs.  Many adults don’t like to play with children, while I truly enjoy encouraging their imagination and insight, by putting the imagined into reality. For children, this engagement with the sand tray represents their inner world, and gives them the opportunity to express themselves and their feelings, and explore different relationship dynamics in their life.

I’ll give an example here.  There was this little boy who was having difficulties at school.  He did this sand tray that was alarming; everyone died.  It was disturbing.  When I met with the entire family, I noticed that one of the parents got totally excited about her daughter, but showed more hesitancy, correction, and judgments toward the client.  The parent had a different way of relating to these two children.

The parent was not aware of this, so to help her notice her responses to her son was helpful.  Originally, the work was all about the boy who wasn’t doing well at school.  But, when you start to look at the family system and relationships, you can see a lot more.  We worked with puppets, and did enactments and movement with the entire family.  Mom began playing with her son and affirming her son’s feelings and thinking; this had a really positive impact.  So, the work is a very lively process, not like traditional family therapy where everybody is just sitting in chairs in a circle.  It’s more of an engaging and creative process.

When working with adults, I always start with a verbal psychological and physical history.  The other day I met with a woman who wanted to work with her dreams, and work through a creative block she was experiencing.  She told me about her history, which included abusive relationships. I suggested she re-enact the dream.

I knew from her history that she had access to her creative and imaginative inner world.  Some people aren’t interested in exploring dreams through role-play, creatively going in that direction, but she was.

She began to act out the dream, and had come to several insights, then came to a part where I suggested she become a character from her dream, which she refused, saying it was too scary. We went to the couch and verbally processed the scary part. Then she chose to engage in bodywork. I proceeded with an intervention that I often do with people who have been abused. I explain that I am going to put my hands on their feet, and I ask them, to ask me, to remove my hands. After they agree, I put my hands on their feet, and I lift my hands off their feet, when directed. I explain that they are in control of how they are touched, and when. Then I will ask them, to ask me, to bring my hands back, when and if they feel comfortable.  I will explain that throughout the session, I will check in often, to make sure they feel comfortable to give me feedback, and tell me to stop. Of course, this is all done with consent from the client; if any client doesn’t want to integrate the bodywork, we don’t go there.

The bodywork intervention brought up a piece of work for this client, and she shared further about her history of sexual abuse.  Often in sexual abuse there’s a past memory of a time, when the person was not able to leave the situation, and became frozen.  This freeze response is part of the “fight, flight, or freeze” reaction which people have in life threatening situations.  Often if the freeze response arises, I will suggest that the person roll from side to side, and notice that they can move, or suggest they move however they like.  I notice a clients breathing while working with abuse. Sometimes suggesting they bring their awareness to the breath, or lack of breath. The holding of the breath, can be an indicator of a fear response, not wanting to feel, or make any noise.  Sometimes a client will push with their hands, creating a limit, a boundary and saying “No” with their movement.

During the end of the session the client was able to embody the character that had at first been scary, and realized that by becoming the scary character from the dream, she could make the distinction between the scary abuser and the helpful internal figure that reflected the creative, vital energy that was arising from her pelvis and sexual organs.

The session was an amazing session to watch and be part of, to be able to make suggestions, and let her set boundaries. She was able to embody the scary and find her vital creative life force.  It was the access through the body that allowed all of this to happen.

KP:  That sounds like a great example of a reprocessing of a traumatic experience.  You are essentially describing a multimodal intervention, similar to “sensorimotor processing.”  These body-mind approaches are considered some of the most effective means of healing certain types of trauma, such as PTSD.  This work provides access to some different terrain than a purely cognitive and verbal focus can offer. 

Janice: I want to say, too, that there was this point where she started to go into the actual memory of the sexual abuse and I thought it was too soon.  With trauma work, it’s important to work slowly, pendulating between positive memories and sensations and the traumatic experience, in order to avoid overwhelming her.  So, at that point, I asked her to try to remember a place that was a positive and safe place in her life, which she was eventually able to do.

So, we were working that edge between the traumatic memory, and bringing her back into a safe place in her body and the room.  This helped her regulate her emotional response, by creating some fluidity between a scary place and a safer place, in contrast to that frozenness, that is so often seen when trauma has been experienced.  Again, all of this was done through access to the body.  This slow, back and forth process was done to avoid emotional flooding, and to help create  new neural pathways – which is essentially, new learning in the nervous system that frees her to shift out of the scared place more readily, instead of getting overwhelmed, or scared by it.

KP:  So, in that one session with the client, she was already starting to experience some shifts in the way she was relating to her trauma history.  That’s powerful.

Next Question: 4.) From your experience, how long goes it take for a client in therapy to get better?