Parents as Partners in Child Therapy A Clinician's Guide

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PARENTS AS PARTNERS IN CHILD THERAPY
 CREATIVE ARTS AND PLAY THERAPY
Cathy A. Malchiodi and David A. Crenshaw,
Series Editors

This series highlights action-oriented therapeutic approaches that utilize art, play, music,
dance/movement, drama, and related modalities. Emphasizing current best practices
and research, experienced practitioners show how creative arts and play therapies can be
integrated into overall treatment for individuals of all ages. Books in the series provide richly
illustrated guidelines and techniques for addressing trauma, attachment problems, and other
psychological difficulties, as well as for supporting resilience and self-regulation.

Creative Arts and Play Therapy for Attachment Problems

Cathy A. Malchiodi and David A. Crenshaw, Editors

Play Therapy:
A Comprehensive Guide to Theory and Practice
David A. Crenshaw and Anne L. Stewart, Editors

Creative Interventions with Traumatized Children,

Second Edition
Cathy A. Malchiodi, Editor

Music Therapy Handbook

Barbara L. Wheeler, Editor

Play Therapy Interventions to Enhance Resilience

David A. Crenshaw, Robert Brooks, and Sam Goldstein, Editors

What to Do When Children Clam Up in Psychotherapy:

Interventions to Facilitate Communication
Cathy A. Malchiodi and David A. Crenshaw, Editors

Doing Play Therapy:

From Building the Relationship to Facilitating Change
Terry Kottman and Kristin K. Meany-Walen

Using Music in Child and Adolescent Psychotherapy

Laura E. Beer and Jacqueline C. Birnbaum

Parents as Partners in Child Therapy:

A Clinician’s Guide
Paris Goodyear-Brown
Parents as Partners
in Child Therapy
A CLINICIAN’S GUIDE

PARIS GOODYEAR- BROWN

Series Editors’ Note by
David A. Crenshaw and Cathy A. Malchiodi

THE GUILFORD PRESS

New York  London
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Last digit is print number: 9 8 7 6 5 4 3 2 1

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Library of Congress Cataloging-in-Publication data is available from the publisher.

ISBN 978-1-4625-4506-3 (paperback)

ISBN 978-1-4625-4507-0 (hardcover)
To my three children, Sam, Madison, and Nicholas,
for teaching me, through all the ruptures and repairs,
the grief and the gratitude,
how to be a parent

To my husband,
for sticking together with me through hard things

And to all the parents who have partnered with me,

for allowing me to walk with their families
through the healing process

You are all my teachers.

 About the Author

Paris Goodyear-­Brown, LCSW, RPT-­S, has been providing clinical care for
families in distress for over 25 years. She is the creator of TraumaPlay, a flexibly
sequential play therapy model for treating trauma; the founder of the TraumaPlay
Institute; Clinical Director of Nurture House; and Adjunct Instructor of Psychi­atric
Mental Health at Vanderbilt University. Ms. Goodyear-­Brown has an international
reputation as a dynamic speaker, an innovative clinician, and a prolific author. She
is best known for delivering clinically sound, play-­based interventions focused on
trauma recovery, attachment repair, and anxiety reduction. She is a recipient of the
Public Education and Promotion Award from the Association for Play Therapy;
has given a TEDx talk on trauma and play therapy; and is the author of multiple
books, chapters, and articles related to child therapy. Her mission is to help parents
and children delight in each other as they stick together through hard times, and to
equip other clinicians to do the same.

vi
 Series Editors’ Note

A s coeditors of the book series Creative Arts and Play Therapy, we are delighted
that the series concludes with this much-­needed book by Paris Goodyear-­Brown.
When parents are engaged, involved, and invested in child therapy, it improves
outcomes that are data driven. Research clearly supports that parents’ involvement
in their children’s therapy process enhances the results, but the methods for the
continuing engagement and investment of this parental involvement are often left
unspecified. This book fills the gap in the literature.
The contributing authors and editors in our series represent disciplines rang-
ing from psychology, to art therapy, play therapy, music therapy, drama therapy,
Eye Movement Desensitization and Reprocessing (EMDR) therapy, and dance and
movement therapy. In this volume, Paris weaves threads from attachment theory
research, neurobiological studies, play therapy, parent training, EMDR therapy,
trauma research, and trauma-­informed treatment into a useful and informative tap-
estry. She avoids the temptation of trying to conceptualize everything under one
theoretical umbrella. The late Salvador Minuchin, when training family therapists,
often urged them to look for complexity and to challenge the narrow view of the
family when defining the problem. Paris has accomplished this for clinicians who,
in turn, will be advising, guiding, and counseling parents.
In our judgment, the therapist’s use of self is always a critical variable in the
process of therapy. Paris is the ultimate encourager, and she offers by example new
hope for defeated and battle-­weary families. Parents can be worn down by clashing
temperaments, strong personalities in one or more of their children, oppositional
attitudes, and argumentative dispositions, without even considering the toll they
may bear when trying to foster the growth and development of a child on the
autism spectrum or with major psychiatric disorders or other special needs. This

vii
viii Series Editors’ Note

book demonstrates how to counteract these negative feelings and behaviors without
invalidating parents, and shows them a new, more rewarding path.
The book is more than a creative set of strategies that can be used to engage
parents in the therapy process. It provides a comprehensive guide to key compo-
nents of the therapeutic work with parents, including psychoeducation when that
is a primary need. A beautiful account appears at the end of Chapter 3, in which
Paris engages a family in making a sand tray together that reveals the various stages
of chaos, struggle, and healing in therapy—from defeated, weary soldiers raising a
white flag because the resources of the parents were overwhelmed by the issues of
their son’s violence, to celebrating in the end the combined strength of the parents
and their son in successfully overcoming the challenges.
Using various creative modes of expression, the book shows us how to work
with parents and families to enable them to overcome their sense of helplessness
and powerlessness. Throughout, there are multiple examples of how to skillfully
shift the perspective and focus of the parents to help them get “unstuck.” In our
more than 50 years of working with children and families, we’ve learned that most
parents have good intentions. But when they are stuck in dysfunctional family
patterns where negativity reigns, the suffering is enormous. This book provides a
respectful and empathetic approach to helping parents. Parents don’t need more
judgment, but they do need more encouragement.
Another contribution is the introduction of hopeful and liberating language,
for example, asking parents to reflect on whether or not their children are in their
“Choosing Minds” prior to deciding what parenting path to take. If the child is at
the mercy of a hyperreactive amygdala and having a meltdown, no amount of logic,
reasoning, or persuasion is going to be effective. Understanding some simple con-
cepts of neuroscience and the “bottom-­up” functioning of the developing brain can
save parents untold quantities of grief and aggravation. Every day in families across
the world, futile power struggles are carried out that lead to sorrow, and many of
them repeat the next day or the day after that. Also, since language is so powerful,
we love that Paris builds on the work of the late Karyn Purvis and refers to children
with histories of trauma and extensive loss as coming from hard places. Using that
language instead of “traumatized youth” ultimately emphasizes the context, rather
than the individual.
This book also covers reflective attachment work addressing the complexity of
the work and skills needed to truly help parents. If a parent is frequently and unpre-
dictably triggered by reminders of their own unresolved trauma, then developing
a highly polished set of techniques is likely to be of little avail. We commend the
author for resisting the shortcuts so favored in today’s world of quick fixes.
The inclusion of the concept of “Window of Tolerance” in Chapter 4 illustrates
how it can be integrated into work with parents in a safe manner. In one exercise,
the author explains how parents can be encouraged to explain what they need in
order to stay in an optimal Window of Tolerance. It is also an effective exercise for
any therapist to engage in to pinpoint what he or she needs to be able to achieve
 Series Editors’ Note ix

and maintain an optimal level of tolerance. Work with children and families can be
emotionally taxing and grueling as well as incomparably rewarding. Self-­monitoring
of our own stress level and our methods of self-­care is essential.
In the final chapters, Paris teaches what she calls SOOTHE skills and practical
play-­based strategies to strengthen the ability of parents to act as soothing part-
ners and to help their children manage powerful emotions and hyperarousal. These
strategies, while useful to most children seen in clinical settings, are particularly
valuable for children who are highly dysregulated due to trauma. Other crucial
topics covered in the later chapters of this book include how to take “delight in
the child,” an important feature in attachment, bonding, and caregiving, and how
to recognize and understand sensory processing difficulties. Paris also guides clini-
cians in helping parents establish boundaries with their children. Following the lead
of Daniel Siegel’s Parenting from the Inside Out, she encourages clinicians to explore
with parents their “hooks,” or the behaviors of their children that trigger strong
emotional reactions in them. Throughout their book, the author offers clinicians
numerous exercises, handouts, and activities to explore these hooks in creative and
playful ways.
We are confident that both new and advanced practitioners will find many
valuable approaches and strategies in Parents as Partners in Child Therapy: A Clini-
cian’s Guide. These innovative and effective methods clearly illuminate the author’s
years of experience as a skillful therapist and provide a roadmap to helping clini-
cians and parents discover partnerships to improve children’s lives.

David A. Crenshaw, PhD

Cathy A. Malchiodi, PhD
 Preface

T his book has evolved as an answer to questions from clinicians who train with
me: How and when do we bring parents into the treatment process with their
children? My answer, after 25 years of practice, is as follows: We want to include
parents as partners in every instance in which it is clinically sound to do so. The
science seems clear enough; inviting parents into the therapeutic process can maxi-
mize treatment gains, but how and when in a course of treatment? This is where
the art of therapy is required, the nuanced responding of curious and compassion-
ate clinicians who can shift fluidly between work with various parts of the system
as they ask the question “What can the system hold?” I am the creator of a treat-
ment model called TraumaPlay, a flexibly sequential play therapy model for treating
trauma and attachment disturbances. The TraumaPlay therapist functions in three
roles with families: Safe Boss, Storykeeper, and Nurturer (all terms that will be
unpacked in this text). We are always working to help parents grow into these roles
over the course of treatment. In most cases, helping parents shift their paradigms
about a child’s big behaviors, expand their ability to hold hard stories, support their
skills in co-­regulating the child with more attunement, and delighting in their child
more frequently maximizes treatment gains. In some cases, caregivers need much
supportive work for themselves prior to being able to step into these roles in their
child’s treatment. In the saddest of cases, a caregiver is simply unable or unwilling
to participate in a helpful way in the child’s therapy. A core TraumaPlay value is
following the need of the child. As we apply this to the family, we are working to
follow the need of the system. This requires a responsiveness that can flexibly move
between individual sessions with children, individual sessions with parents, dyadic
sessions with one parent and a child, and potentially full family sessions. While
there is broad-­reaching support in the literature for the incorporation of parents
into the therapeutic work of children with a wide range of mental health concerns,
xi
xii Preface

there is overwhelming research support for the enhanced efficacy of treatment

when we include parents in treatment specific to complex trauma and attachment
disturbance.
We have a treatment center called Nurture House in Franklin, Tennessee. It is
a single-­family dwelling that has been refurbished to offer a multitude of safe spaces
to help families and children heal. Attached to Nurture House is the TraumaPlay
Institute. We train clinicians on-­site, doing practicums in the treatment rooms of
Nurture House; we provide online continuing education; and we offer trainings
all over the world. The TraumaPlay model is an umbrella of evidence-­informed
treatment components, each supported by a series of interventions, both directive
and nondirective, that are developmentally sensitive and help families move toward
healing when hard things have happened. The TraumaPlay treatment flowchart is
shown in Figure P.1.
Although this flowchart looks linear, we offer our trainees a graphic that frames
the goals within a pinball machine (see Figure P.2), because the fluid nature of the
model relies on the clinician making nuanced choices that follow the child’s need
along the way. While the TraumaPlay model has been written about in depth else-
where (Goodyear-­Brown, 2010, 2019), this volume is focused on how we help parents
become partners in their child’s therapeutic healing. Notice that the ­TraumaPlay
component focused on soothing the physiology has two substreams. The first involves
enhancing self-­regulation for the child, but the second arm involves enhancing the
role of parents as soothing partners. Chapter 5 will focus specifically on the set of
SOOTHE strategies that we offer to parents as we help them increase their ability to
co-­regulate their children. The other area in which a parent plays a key part in treat-
ment is as a child’s Storykeeper. Clinicians understand that we are only in a child’s
life for a period of time and we want to create coherent narratives of hard things
within the family. Parents are welcomed and incorporated into any or all of the key
components of treatment. Part of the clinician’s ongoing role with the family is gaug-
ing when and if parents are ready to be involved in treatment. Are they big enough
containers to hold the story? Are they regulated themselves? Will the parent add to
the corrective emotional experience of a child in any given session? When are col-
lateral sessions best, and when are conjoint sessions the most effective way to bring
delight back to the system? We provide a combination of in vivo session work with
parents and children together, parent coaching and reflection sessions for parents
themselves, and sessions with just the child or teen.
All of these questions are addressed in supervision, and, at Nurture House,
parents are pretty frequently and fluidly moving in and out of sessions with their
children. We also do an enormous amount of parent coaching sessions and sessions
that involve Reflective Attachment Work (RAW) with parents on their own. Our
team sees families in every kind of distress. We see many adoptive families in which
parents are raising children with complex trauma histories. We see parents who are
trying to figure out the best way to parent an anxious child, a child of divorce, a
child who struggles with impulsivity and focus. While specific skills sets may need
 xiii
FIGURE P.1. Key Components of TraumaPlay.
 ESS

pi
ng Soothe
Co

Phy
siology
rents a
Pa Shift
s

Co-Regulation
Partners
Delight

Emotional Literacy

Continuum of Disclosure/
Posttraumatic Play
Trauma
re ual

Narrative
Pla

osuGrad
y-B
ase

Experiential
Exp
d

Mastery Play

On
go ent
ing essm
s
As Making
Addressing Positive
the Meaning of
Thought Life the Posttrauma
Self

Graduation

FIGURE P.2. TraumaPlay Mapping Tool: Fluidly Following the Child’s Need.

xiv
 Preface xv

to be enhanced differently in some of these cases, we have found that the essence of
the paradigm shift we want to help parents make is that as they stick together with
their kids, they can do hard things. Parents have the hardest job in the world . . .
and the most rewarding one. Helping parents see their essential value to the tiny
humans in their care is one of my greatest joys. Parents often need someone to
believe in them, to help them breathe in their power to help their children heal and
grow. It is our great privilege to walk with them along the way.

How to Use This Book

Throughout the book, I will highlight important paradigm shifts we help parents to
make. Handouts that will be immediately useful to you in sessions will be offered.
Case examples will also be woven throughout. I have attempted to use gender-­
neutral or gender-­inclusive language throughout the book in an effort to avoid bias
toward a particular sex or social gender. Also, I have attempted to use gender-­
neutral language in the handouts themselves, in order to recognize that a variation
exists in who may be mothering, fathering, or providing daily care for a child from
a hard place.
In most of our parent training work, we include in-­session prop-­based exercises
that encourage both left and right hemispheric engagement, supported by handouts
that parents can take with them. These may serve as transitional objects from the
therapeutic space in which the parent has started experiencing some success—­
some shared delight and enjoyable moments with their child—­to the much more
difficult home environment.
The use of concrete tools, such as handouts, to support therapeutic homework
for parents serves several purposes. In this case, they offer the following benefits:

1. Exercises designed for parents help communicate that they are a really
important part of creating change in the system.
2. The exercises offered through the handouts help support the clinician’s
work with parents all along the way.
3. Some handouts are meant to provide psychoeducation and important para-
digm shifts.
4. Some of the handouts help parents to practice new adaptive skills sets in a
supported way, encouraging small doses of positive practice that can gener-
alize to other situations.
5. Some of the handouts are geared toward supporting corrective emotional
experiences as parents reflect on their own attachment history with a deeply
curious and compassionate clinician.
6. They offer a level of accountability outside the session for response patterns
practiced in sessions.
7. They set the stage for the therapist’s celebration of a parent’s hard work.