As a fresh-out-of-graduate-school social worker, I remember being open and excited about the opportunities ahead. My first job in social work ended up being an early childhood mental health specialist, which I quickly felt unprepared for and was challenged by how to apply the theoretical concepts and interventions I learned in school to the young children on my case load. What are the stages of change for a five year old?
Can you use Cognitive Behavioral Therapy with a preschooler?
How can I teach a lower-functioning four year old about “deep breathing” when the child does not even understand that terminology?
It didn’t take me long to remember that the social work principal of “meeting clients where they are,” was exactly what I needed to do.
When one understands the brain and the development of the brain, one realizes that children learn through experience. Just as young animals can be seen on National Geographic pouncing playfully on their mothers and pawing joyfully through foliage after insects, children also learn, explore, and heal through play. Through the repetitions of motor skills and behaviors such as in play based behavior, brain activity is altered and the brain changes (Kolb, 2009).
Truly comprehending this understanding of learning through experience and the undeniable power of play in learning, growth and development, changed everything for me in how I related with clients and families.
I began taking known concepts, theories and therapeutic interventions and making them tangible. Instead of expecting a young child to talk about their day or process through stressful and traumatic experiences verbally, I began to use story stones. These are tangible rocks with small pictures on them that children can use to show the linear progression of an occurrence and identify the changing feelings in the story as well as what could have been done differently to change the outcome of the story (take stone representing yell and throw things and replace with a stone representing a coping skill). These pictured stones also became a sorting game where clients would sort the pictures based on emotions they elicit for them, thus identifying triggers and leaving opportunities to process unresolved trauma-related experiences and gain self awareness and self perceptions. Who knew some little grey stones could be such a powerful tool in any social worker’s office?
Deep breathing became an active and interactive experience as I taught children to use pinwheels to notice their breath as it leaves their body. Children squealed with joy as they were able to notice the difference between short breaths and more extended, slow breaths on the pinwheel’s movement.
I would “slow race” children by each breathing slowly on a pinwheel and seeing who’s lasted longer to practice releasing breath more slowly. I also have used an expanding sphere to illustrate deep breathing and using the whole lungs to breathe in (while expanding the sphere) and breathe out slowly (while condensing the sphere again). Adults enjoy breathing with the sphere as well!
Cognitive behavioral techniques became a fun “thinking x-ray machine” where the internal thoughts of puppets could be explored and changed to help the puppets feel happier.
As I continued with these tangible interventions, I began to realize they were not only effective with young children, but also, with older children, teens, and even adults. During family sessions parents would make remarks such as, “Wow, I never thought of deep breathing that way, that’s really cool,” or “Can I also make a play dough sculpture of what I think my anger looks like?” I have had parents initially scoff or question the idea of using play in therapy and then find themselves on the brink of tears in sessions as they witness and participate in social and emotional learning and healing in a whole new way.
There is actually brain science to prove why new tangible interventions are so powerful across the life span. First of all, research as proven that tangible interventions that use more of the senses (such as touch and hearing, sight and smell as opposed to just hearing) access more of their brain to process the information. This makes the experience more integrated in the brain, thus more impactful and more likely to be remembered. So asking a client to recall a positive memory to use this week as a coping skill is more impactful if you have them also draw and/or write about it (even better with scented markers)
Neuroscience is paving the way in social work because neurons and connections in the brain can be studied. These connections represent our typical patterns of thinking, responding, and behaving and are hard wired from experiences in our lives. Neuroscience also proves that new neural connections can be made despite existence of other less helpful pathways. When an individual experiences surprise or an unexpected occurrence, this hard wires into the brain much faster and new pathways are formed without as many repetitions. So when you simply talk about deep breathing to a child or adult as a coping strategy that is helpful but when you introduce some more surprising and sensory related stimuli to practice this skill, the pathway is formed much easier and more quickly in the brain.
My first therapist position out of graduate school may have been challenging, but it pushed me to seek new ways to reach clients, which has changed everything for me as a therapist and as a social worker. I have been both humbled and inspired by the resilience, growth, learning and healing capacity of clients when given the tools to fully access what they need. Tangible social work isn’t just child’s play, it’s neuroscience, and although it is not always easy, it is always worth it.
Kolb, B. (2009, December). Brain and behavioral plasticity in the developing brain: Neuroscience and public policy. Paediatr Child Health. 14(10), 651-652. doi:PMC2807801