Case Studies

"Emotional

Laura, aged 4, Developmental Delay / Speech, Language & Communication

Following a difficult and traumatic birth, Laura had had lots of medical problems and was referred to me as she was struggling with emotional regulation and communication with others.

Unable to make herself understood she was having regular ‘meltdowns’ and screaming inconsolably for hours on end. She was having great difficulty in settling in school and was hitting other children. As well as communication problems, her coordination and fine motor skills were particularly delayed.

Laura attended 18 sessions of play therapy and was able to develop better communication skills, empathy for others and express herself in a way that was not dependent on language skills.

Laura now has far fewer ‘meltdowns’, is settling well in school and is able to play and communicate well with other children.


Sion, aged 5, Selective Mutism

Sion was 5 years old. He was referred to me due to concern that he was not speaking at school. According to Mum, Sion was perfectly able to speak at home but his teacher reported that she was unable to get him to speak at all in school. Sion had been assessed by the speech and language team and it was suggested that the problem was an emotional issue, namely selective mutism. Selective mutism is an intense fear of talking. Often children with selective mutism can speak perfectly in situation where they feel comfortable such as at home with close family, but in social situations such as in school the child feels totally unable to speak.

Sion had a good circle of friends and seemed a generally happy boy. There was no apparent trauma or difficulty in his background and the cause of this problem was a mystery to both Mum and the school, but was clearly causing Sion a lot of difficulty. His teacher felt that his mutism was severely holding him back educationally.

Sion was invited to take part in some play therapy sessions. When I begin working with a new client a set of rules is negotiated between me as therapist and the client.  In every other aspect of his life Sion was being encouraged and coaxed into speaking, which although totally necessary, stressed Sion out. Sion and I decided that, in play therapy, neither Sion nor I would speak until Sion was comfortable to do so, thus allowing him a safe and comfortable space where Sion could express himself and his worries non-verbally.

In time, through non-verbal non-directive play therapy, I began to understand Sion. Sion was a very sensitive little boy. Through his drawing and sandplay it became apparent that he had developed some anxieties about the safety of his little sister, mother and father and what would happen to them when he wasn’t there. These anxieties had become very powerful and were manifesting in his inability to speak when he wasn’t with them.

Sion took part in 18 play therapy sessions at school; he worked through his anxieties about his family by painting, using puppets, in the sand tray and through music. By the end of the intervention he was far more confident, was speaking in the classroom and was sleeping well.


Maikka, aged 7, Early Neglect, Attachment, Adoption

Maikka was 7 years old and had been living with her adopted family for two years when she was referred for play therapy by her Educational Psychologist.

Maikka really struggled with communicating with others. She wasn’t able to interact with her peers due to her behaviour and was isolated from other children as she often hit out and bullied other children. She damaged a lot of property at school and stole from other children. Maikka had been severely neglected from birth and was removed from her family at 2 years old. She had a very disorganised attachment style and her adoptive mother reported that it was if she wasn’t able to receive love and did not feel any emotion other than rage. Maikka had a lot of meltdowns and would take a long time to calm down afterwards. She would destroy lots of things in her meltdowns and then have no memory of doing so. Maikka’s behaviour both at home and at school was becoming increasingly difficult to manage.

She was diagnosed with an attachment disorder. Attachment disorder can happen if children have not been given satisfactory care and love, or their interactions with adults have been frightening and unpredictable in their early years. This makes it very difficult for them to form relationships and have normal human social interaction.

Maikka received a long term intervention which lasted just over a year. Interventions of this length are unusual, however due to her difficulties, Maikka needed intensive and long term support to develop a therapeutic relationship and to learn to trust. Maikka developed better communication skills, was better able to focus in school and developed a deeper attachment to her adoptive family. She became able to feel and express emotion (which was very scary for her at first), feel some empathy towards others and developed some warm friendships with her peers. Maikka’s case was so severe that she is likely to always have difficulties at some level, but through this intervention she was able to experience normal human interaction, develop much better emotional literacy and regulation (less meltdowns!) and most importantly of all, Maikka was able to feel and accept that she was loved and safe, which is a huge improvement.


Michael, aged 15, Parental Separation / Cannabis

Michael was 15 years old, a very likeable and clever young man. He was also developing a daily cannabis habit. Michael was usually well-behaved, sensitive and a high achiever in school. Recently he had got in with the ‘wrong crowd’, spending a lot of time out of the family home whilst his mother and father were going through a messy and acrimonious divorce. He began using cannabis with his new mates for a laugh, soon learning that being ‘stoned’ relaxed him and stopped him from worrying about his parents and their break-up.

I was contacted by the school welfare officer because they were worried about Michael. His attendance at school was dropping, he wasn’t completing his homework and his Mum had contacted the school for some advice when she had found cannabis in his room.

Michael participated in 6 therapy sessions. His cannabis use dropped to almost nothing. Although he was still upset and worried about his parents and their divorce, he was able to work through these feelings with me. His school attendance improved and he got himself an modern apprenticeship to begin at the end of year 11.


Callum, aged 4, Behavioural Difficulties / Medical Issues

Callum was referred for therapy by his school due to his inability to concentrate in class and being disruptive. Callum was on a waiting list to be assessed; his teacher suspected that he had ADHD and a possible learning difficulty. He was boisterous and rough in his play with other children and didn’t have many friends. He hit out and was unable to focus for more than a few seconds.

Callum had spent over 12 months in and out of a children’s hospital due to having heart surgery. Mum felt that Callum did not have ADHD but might have some developmental delay due to the time spent away from other children (due to risk of infection) and the amount of time spent in hospital. Children who experience long term illness often miss out on some of the messy developmental play.

Following assessment, Callum was offered 12 play therapy sessions. During the sessions Callum and I worked through some of Callum’s feelings about his fear of hospitals and doctors and his belief that everyone thought he was a ‘naughty boy’.  He was upset because he thought other children didn’t like him.

Callum calmed down in the classroom and his self-esteem improved. He went on to receive support from the behavioural support service. His mother contacted me a few months later and reported that Callum seemed happier, was smiling more and was beginning to form friendships with other children. He was being included in birthday parties and had even been invited to another child’s house to play which had never happened before due to his behaviour.


Toby, aged 6, Asperger’s Syndrome / Social Isolation

I was contacted by Toby’s mother, who had heard about play therapy and who was desperate for help. Toby had Asperger’s Syndrome which is an Autistic Spectrum Disorder (ASD).  Asperger’s is characterised by significant difficulties in social interaction and nonverbal communication, alongside restricted and repetitive patterns of behaviour and interests. It differs from other autism spectrum disorders by its relative preservation of linguistic and cognitive development.

Toby was lonely. He attended a mainstream school with support. He did not know how to play with other children and was easily frustrated by their lack of interest in his favourite things which were trains and clouds. Toby was so interested in trains and clouds that he literally could not talk about anything else most of the time. The other children could sense that Toby was ‘different’ to them and easily got bored of trains and clouds.  Toby got angry and sometimes hit out at the other children when they got bored and wanted to play or speak about something else. Toby soon became isolated and withdrawn from his peers.  All the important adults in Toby’s life tried to discourage him from talking just about trains or clouds. They tried to get him interested in new things. This frustrated Toby too.

Toby was offered 12 sessions of non-directive play therapy. Non-directive play therapy is guided by the child with as few rules as possible (but enough to keep everyone safe). This gives ownership to the child and a relationship based on equality between the child and the therapist.

Toby was delighted to be able to talk and play with me, about trains and clouds. Trains and clouds… Trains and clouds… Every session was based around trains and clouds until I had learned everything there was to know about trains and clouds and had played every game that Toby could invent (which were of course based on trains or clouds!).

In every other aspect of his life people were tired of hearing about trains and clouds. Toby was encouraged to find new interests. However, in play therapy sessions he was able to express his love and interest in trains and clouds to his heart’s content. He also expressed his frustrations that other people did not share his enthusiasm for his passions. I was able to hook into this frustration to help him to process this and help him to move on.

After a while, Toby’s mother saw that he was calming down generally, that he was beginning to show a healthy interest in other subjects. He began to be able to listen to other children without interrupting as much. Slowly, Toby began building relationships with other children.  Toby will always have Asperger’s Syndrome. This will not change, but through the play therapy intervention, by working with Toby in his way, Toby was able to make some really positive changes.


Dean, aged 10, Parental Separation

Dean’s father and teacher were desperately worried about Dean. Six months previously, on Christmas day and with no warning, Dean’s mother had left the family home and set up home with a new partner. Previously to this, Dean had been an above-average student and had been a happy and caring young man.

Since his mother left Dean had become withdrawn at home and at school, his school work had deteriorated and he seemed sad all the time.

I was asked to work with Dean. He received 12 play therapy sessions at school and I supported him to use this time to work though his feelings about Mum leaving. It is incredibly frustrating to be 10 years old, to be desperately upset about something and to be powerless to change it. All Dean wanted was for his family to be back under the same roof and for his mother and father to love each other again. Dean and I worked through his feelings of being powerless, of loss and his anger about the situation.

Play therapy does not have the power to change the circumstances of children like Dean, but is very powerful in changing how children respond to and their feelings about the complex circumstances they often find themselves in.

Following the intervention, Dean’s father reported that Dean was more accepting of the situation, less angry and “like the Dean that I used to know before his mother left”. His teacher reported that Dean seemed much happier in the playground, messing about with his peers and less withdrawn in the classroom.  His educational attainment returned to what it had previously.


Naomi, aged 14, Alcohol Misuse / Parental Substance Misuse and Mental Health

Naomi was a young woman of 14 years old. She was regularly drinking alcohol and getting into fights, engaging in anti-social behaviour and seen as generally ‘out of control’. Her family had had years of social services involvement and now Naomi was on the verge of being kicked out due to her mother being unable to cope with her behaviour. Lots of services were involved to try and resolve the issues. Naomi had been excluded from numerous schools and wasn’t attending at all by the time I met her. Naomi had been identified as having a speech and language disorder and was virtually unable to read or write.

I was asked to meet Naomi and see if Play Therapy might help. It was clear to that Naomi was drinking alcohol to ‘block out the world’ and that her self-esteem was very low. As a child Naomi had witnessed domestic violence and parental substance misuse and seemed to have no hope for the future or belief in herself.

Naomi reluctantly agreed to take part in some play therapy sessions. At first she sneered at the toys, and laughed as Emma tried to engage her with the bongo drums. She often said “I’m 14, not 6 you know!”, however, slowly Naomi began to take an interest…

Naomi was well-known for not turning up to meetings with professionals and being difficult to engage but for some reason she turned up for every one of her play therapy sessions…  She slowly began using the sand tray, using symbols to tell her story. She began creating collages, communicating in a way she had not been able to before.

Within six weeks, Naomi began turning her life around. Her behaviour had improved (as reported by Mum and the community police officer), she was smiling far more often and best of all she had virtually stopped drinking.  She had attended an interview to start college. Her relationship with Mum had improved dramatically. Her journey continues…


*Permission for case studies obtained by clients and parents. All identities and identifying details have been changed to protect and respect privacy and confidentiality*