Themes in Therapy
At the hub we use themes to break down what is happening under the surface of what’s occurring within the therapy session.
I am often asked how I know therapy is working and when it’s not. Tracking themes within therapy can help me recognise and communicate with families about what to expect and when.
What do we track?
Aggression - can show up in therapy by
Fighting - with swords, where the therapist and child are fighting ‘against’ one another
Fighting on the same side - we are a part of the same team and ‘villian’ is something else (could be puppets, teddies, small figures, drawing of the enemy.
Natural disasters, conflict, war and violence in story lines
Death dying
What could this mean?
A nervous system that's on high alert
A nervous system that’s shutting down
A child is exploring how to keep themselves safe, or exploring a potential threat
A child is integrating past experiences into the here and now
Exploring how their bodies feel and how to co-regulate with someone else.
Disconnection - how can it show up in therapy?
A child being disengaged in play or any time of conversation
Looking around the resources and being undecided about what to choose and use.
Yawing or feeling bored or tired
They stop you from playing or ignore you
A teenager may present with minimal conversation and finds it challenging to pinpoint areas of interest or areas that need support.
What could this mean?
A nervous system which is shutting down
A child may be in self-preservation mode
They may be feeling lost, hopeless, helpless or stuck.
Criticism - how can it show up in therapy?
A child may directly criticise you or your work
They may notice your mistakes and name them.
May comment on the playroom negatively
As therapists, we may notice our imposter syndrome increase
What could be happening?
The nervous system is hypervigilant and is reaching for perfection at all costs
They are experiencing negative self-worth and not feeling good about themselves.
Maybe finding it hard to process and deal with expectations set by others
Low self worth.
Control - How does this show up in therapy?
Boundary testing
A messy playroom
Emptying resources, including sand
May use storylines based on cops and robbers
May take an authoritative role within the therapy space
May change the rules to the games to ensure they win
May change rules frequently to meet their needs.
This is a small snapshot of some of the themes that can be present within the therapy space and how to recognise them. In some sessions, all maybe present and in other sessions it maybe focused around one.
