Play in Clinical Practice by Russ Sandra W.;Niec Larissa N.;

Author:Russ, Sandra W.;Niec, Larissa N.; [W. RUSS LARISS A N. NIEC, SANDRA]
Language: eng
Format: epub
ISBN: 655566
Publisher: Guilford Publications

In TF-CBT, relaxation skills are taught to children to not only help them manage general feelings of stress, but also to help anxious and/or avoidant children cope with the anxiety and/or avoidance triggered by the therapy process itself. Relaxation skills help youngsters to feel a greater sense of control over the anxiety and fear they may experience when confronted with abuse reminders in the context of therapy (Deblinger & Heflin, 1996). When relaxation skills are introduced, they are geared to the child’s developmental stage and are often playful in nature. Youth, particularly teenagers, may be taught progressive relaxation including guided tension-releasing exercises. The recommendation of Koeppen (1974) to include fantasy in relaxation to maintain the attention and interest of younger children is integrated into the majority of current examples of relaxation exercises with children. For example, Barbara Bonner and colleagues created a script called “The Land of Dinosaurs” which guides children back to “the time of the dinosaurs,” imagining they are “huge” dinosaurs with “long necks” to stretch up to the tall trees to eat the leaves. The “dinosaurs” are guided to lie down on the ground, feeling the sun shining on them, to stretch out, to take some deep breaths and fill their “gigantic lungs” up with air, and to slowly release the air. The script continues to guide children through relaxation exercises including stretching, progressive muscle relaxation (e.g., tensing the jaw and then releasing it, lifting the shoulders as close to their ears as they can as they try to get under low hanging trees), and breathing (Bonner et al., 2003).

Simpler imagery may be used with younger children by asking them to pretend that their body is in a state of tension, like a “tin soldier” or an “uncooked piece of spaghetti” and then after a count of five to release their bodies into a state of relaxation like a “wet noodle” (Deblinger & Heflin, 1996). Another way to introduce relaxation to children includes controlled, belly breathing. For example, children are asked to imagine the expansion of their stomach on the inhale “as if it were a balloon being blown up,” and then to imagine on the long exhale that the balloon is flying away as all of the air is being released from it. In another example, presented by Runyon et al. (1998), an expansion was made on a muscle relaxation sequence originated by Morris and Kratochwill (1983) to include fantasy: children are instructed to pretend they are blowfish, “take a deep breath and hold it for 10 seconds, hold it in like a big round blowfish, and let it out watching the air bubbles float up through the water. Raise both of your hands about halfway above the couch and pretend that you are reaching for a colorful rainbow, breath normally, then drop your hands and relax.” Another example of a playful way to introduce controlled, belly breathing includes the use of bubbles. Children are provided a container of bubbles and are encouraged to practice slow, controlled breathing with deep inhales and long, deliberate exhales as they blow bubbles.

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