Thérapie du trauma

Developmental play and traumatized playfulness,

 

Kathleen OLIVIER

 

 

 

Introduction

 

A young student, I had to make choices about the profession that would fit with my person. Being asked about what was my passion, I would answer: “People”. Indeed I always had a great interest in observing how people are so different and react in so many ways to the environments. Soon I felt I wanted to work with the people which had more trouble getting over life events and that through playing “as if” there was a way they could transform something and render their harsh interaction with the world something soother and more joyful. Certainly when I got to read the work of dramatherapists, I could put other words and theories on my spontaneous intuition.

Being interested in development, I got involved in Sue Jennings's work and the questions she rose on the stages of development in every human area (cognitive, sensory, physical, relational, imagination) that could be stopped in one's story by life events and more importantly which could be worked on again in the therapeutic process. She proposes the neuro-dramatic play techniques particularly with looked after children. It enables sensory and rhythmic play, developmental paradigm of embodiment-projection-role, containment and reassurance for children who are out of control, therapeutic story telling that mirrors the child's situation.

I met David Read Johnson's process of developmental transformation that I had the chance to experience and where I really understood the here and now aspect of therapy and the effect of being honest on recognising that people on stage are doing as if which allows to go quickly to the real matters and transform something in the interactive encounter.

Mooli Lahad's work was for me a theoretical standing point on the way I wanted to work: evaluating one's spontaneous ways to cope and rebound in difficult life situation, relying on the strengths and then develop other strategies if possible. Through observation of children in bomb-shelters and community centers, he found that children dealt with the events ans shocks in their own way. Some played sport or danced (physical), some others talked logically and rationally (cognition), others showed and shared their feelings (affect) others prayed or in some way acknowledged a higher power (belief), many children shared and played with their friends (social) and yet told stories and developed creative activities (imagination). All of these children had a different and resilient way of “meeting the world”. Robert Landy's theory on roles coined for me how dramatic roles one enacts in the therapeutic place can tell about the person's state of personal development and how through role taking and role playing one can increase his possibilities to interact and react to the people around.

 

Looking for writings in french I was half surprised to have so many difficulties. Finally, the only french book I will refer to was written by a collective gathered by a psychomotrician, F. Joly. Indeed, our psychotherapies mostly rely on psychoanalytic theories and do rarely include body work. Psychoanalysis had been working on trauma from its early concepts however, and it is a freudian concept that proposes putting into words the origins of the issue to help release the symptoms. Traumatic neurosis is distinct from the most common neurosis in the sense that while the symptoms observed in neurosis come to represent symbolically a memory that has been forgotten because it was linked to some sexual fantasies; in traumatic neurosis, memories are not forgotten but on the contrary are repeatedly reactivated in nightmares or flashbulbs. And when the psychoanalytic treatment for neurosis is to help express the original trauma, in traumatic neurosis, the goal would be to help the person forget this memory so that s/he can reconnect to the time-line and not remain stuck in a perpetual horrific repeated present. In France, the trauma treatment technique which is mainly known is Eye Movement Desensitisation and Reprocessing which is mostly used with the eye movement approach that doesn't include much touching. I recently learned that the Psychodrama team in my hospital actually recommends forbidding touch (freudian Psychodrama) to prevent any risk in terms of violence or abuse. I am witness of a very old tradition in therapy that can explain why it is so difficult for dramatherapy to take place over here. Last year the first master program was created in Paris, but for now it mostly gathers the psychology and fine arts department and offers very few experiential workshop...

 

The experiences I will present in this article all take place in the practice I have as a psychologist which allows me to work in psychiatry. But spontaneous embodied interactions take place in my office where my box of props, masks, blankets and puppets seem to inspire the kids. Also I will include some vignettes from the dramatherapy group where I propose some playback work.

 

 

1. Playing

 

“I feel my daughter is using me, she only wants to play with me !!”, is how a father told me one day about the child they had adopted less than one year before. Play was perceived as the non-serious part of the world which therefore could be dismissed…and this is also what allowed this girl to play the most important part of what she felt, thought, feared and hoped while parents let her do: “it is only playing, it doesn’t matter!”. This is also what we, dramatherapists, are using all along , touching the most intimate part of stories doing “as if” it was only a created world far away from reality and therefore helping change without so many resistances…I am regularly educating parents about the importance of playing and explaining how it is at least as valuable than homework for development...

 

When does play begin?

 

Sue Jennings (2012) insists on the beginning of play long before baby gets to breath for the first time. Already in the parent’s imagination about the future child and about their interaction together, a place is given (or not) to the different possibilities these encounters can become. Taking care of pregnant women is so meaningful particularly when playful interaction and daydreaming cannot take place spontaneously due to difficult parent's life events. Singing for oneself and soothing the inner child of the arent as well as the growing being inside, cuddling oneself as a boat for the sailor, talking aloud and inventing stories of what it may be when they will meet, telling stories about the family, about the past and the present; feeling good in physical (swimming, walking, dancing…) and sensory (eating, smelling, massaging) situations is also preparing one’s child for future abilities to do it for him/herself (p.41).

 

What is play?

 

As soon as baby is out in the world, what is seen as developmental, physiological, psychological patterns can also be considered as play patterns. I propose we can try to look at the child’s behaviors through six different purposes of play .

 

Sensory pleasure.

 

Sucking, touching, smelling, having things in one’s mouth, seeing color and lights, shapes, faces, hearing voices and music, being tickled, embraced, stroked, kissed. All senses take part of the encounter between the new born and the external world. Play can happen when these sensory interactions are positive. By this way, the child gets in touch with the surrounding world, incorporating objects, but also discovering what is his own body and the other’s. The sensory repertory of the mum can however sometimes destabilize the inner balance of the child or balance again by soothing the intensity of images, assuming containment and “pare-excitation”. It is only around six to eight months that the child can actively accept or reject the mum's stimulations (Candilis- Huisman, in Joly, p.121). A child who is sick, mistreated or not held appropriately cannot have his body free for sensory pleasures and may have a hard time entering in a playful mood if possible ever. He may also display quite stereotyped kind of games: classifying, organising, or just destructing relationship with the other to avoid the risk for unpleasant encounter... I met a teenage girl who had gone through different separations in her life and showed a surprising attraction to all the messy games: smelling and touching paint, glue, corrector liquid, putting it in her mouth, getting her hands full of sticky and wet materials, building and destroying her creations; and during all of this she was checking that I was giving her the right to be in this way. She was alternating this kind of embodied play with some projective play (drawing, plasticine). After more than a year she could change the could try the role games. Jennings (1998) explains: “The child who expresses their chaotic and messy experiences may do so physically or projectively or dramatically: for example through physical destruction or bodily aggression or self -harm (Embodiment), or through daubing, graffiti or fire raising or physically destroying her picture (projection) or through playing the part of the bully or the victim or the destroyer (Role). The play can help to re-establish those creative processes that are at the heart of 'good enough attachment' and later resilience' (p.145).

 

Mastery.

 

Playing can be a way to find a just balance between control and letting go which is necessary to be able to adapt adequately to everyday events. Through holding the objects, catching, throwing, building, destroying and building again, the child gets to feel he has an impact on the environment. When the shouts, the cries are followed by the adequate response of the caring person, coming and checking what is going on, the child feels his communication is worthwhile. When there was trauma, the child or adult may have a hard time trust the environment again, and when some cues may trigger overwhelming flood of sensations that may appear like loss of control; the individual will most of the time try to protect himself by preventing these interactions with the world and therefore blocking any possibility for being free and play. Quelin-Souligoux makes the difference between game when on needs clear rules to hold and be protected from the unknown disorganised and play where no rules need to be set before. I have met a young patient whose mother, due to mistreatment and abuses herself, couldn't take care of her child for the two first years of life, hopefully, the dad could replace most of the caring relationship. However, in a puppet game, the boy came to create a story where a baby crocodile was being attacked by a big crocodile and no one was coming to help, calls to the mum were tried and not followed by any apparition of a protective figure. The same child was playing through masks a story where he was completely petrified in front of an aggressor without even the possibility for shouting, it is only through exchanging roles with me that he mirrored some actions and could come out the state of impossibility for movement and find new possible ways out. Quelin-souligoux (in Joly, p.159) describes that kids experiment with their need for power in a creative way when it is bounded by “as if” and taking care of the other in game.

 

Limits and boundaries

 

It is through going beyond the limits that one gets to know where they are. Why did you do it?”, did I ask a teenage girl who asked to go out the room while one of the carer was not there. She had the guts answering that the missing carer had told her it is “forbidden”. Finding the right place between oneself and the other; trying to respect people around while not getting hurt oneself, this is something really not easy to reach. Even more when others, and adults from one's close family circle in many cases, have been acting a way opposite to the social laws. In the group I am running, the basic rules are said in the game: don't hurt physically or mentally, don't injure yourself, don't destroy objects that belong to others...and then anything else is allowed in game...fighting, killing, kissing, saying bad words...But in game kids need to be sure where are these social limits: “I would be your husband and kiss you, but I know, not for real”, said a boy, living alone with his adoptive mother and working on his oedipian issue. “You play your role, and I play mine, you are the therapist and I the child, and you ask me questions.” said a teenage girl asking next session that we role reverse so that she can be the “therapist” who states strongly the limits like “don't talk like that to me, or go out, or I call the educator!” and “This is private, I won't tell you!”. It was quite strange how this role reversal with my therapist role happened twice in ending sessions. I felt we may have reached intimate play as coined by Johnson when “the play is about the here and now relationship between the therapist and client and what is occuring at the moment” (p.92). Indeed in play, these different places can be rehearsed for real so as to integrate or reject part of it. I felt the kids were finally working on clarifying their own personal limits that had been violated in their childhood and were so undefined when we met.

With many of my small patients, working on the “doing as if” seems not to have been so clear before. It is the way they voice it when they catch the rule that made me realise it was not acquired before. The teenage girl I evoked earlier actually had to tell me “I did this and said this because it was not for real” to justify the aggressive way her character was talking. By doing so, she was also checking the boundaries of what was allowed and not allowed in terms of violence between us. When she proposed to reverse roles with me, she could talk to different teenage girls representation and adapt to their behaviors. Patients can incorporate new rules so as not to replay the same abuses with his own children. As the client’s play-object, the therapist becomes an animated presence that the client must contain (Weber, p.67). The roles of container/contained are partly reversed (Read Johnson). With kids who have experienced abuse and displaying overprotective or unadapted distanced behaviors, playing together with the therapist helps become active in setting themselves boundaries where they feel the relationship is bearable.

 

Being together and feeling in a safe environment.

 

In the first times of the relationship, the newborn child shows capacity for imitating the face presenting to him -mirroring someone who takes his tongue out is possible in the first hours of life! Imitation games are the ones that spontaneously emerge between the child and his mum, his father, his sibblings. The caring figures also rapidly come to imitate the toddler in his gestures, sounds, emotions expressed, giving him in a mirror a proof of his existence for the other. This is accompanied by a great charge of pleasure by both partners of the game. This interaction is the key for empathic abilities but also the trust one is important and desired by the other. It often takes time to create enough trust so that one can start playing together, but this is when this therapeutic relationship starts that new ways of being with the other appear. For Johnson, the therapist must keep his attention on the client communication on all levels, and give empathic feedback in embodied imaginal form. Many of the kids choose games where they keep control and distance for some time, or they enter in a more emotional game that they exit rapidly...In some mother-child relationships where being together was charged with difficult emotions, a survival choice had to be made to avoid or attack this interactions. Playing allows a new entrance in relationship trough an indirect way, contrary to talking where a direct interpersonal reaction is expected which may just be impossible in such cases. One of my little patient only tells her story in role play and when I try to make some link with her real life, she gets to protect herself doing as if she didn't hear, she could recognise it is too difficult for her to talk about the real person in her life. In play, the attention is somewhere else than on the two partners, the object is external and destined to give pleasure, it is a perfect way to restore trust. “The purpose of not including a set aside time for deroling or verbal commentary is consistent with the overall goals of this therapy which are to become present rather than to gain insight” (Johnson on developmental transformation). In some cases, time to make conscious link between the game and reality appears necessary to be sure the child doesn't completely separate her imaginary and real identity and foster a personality disorder...debate is not over...

 

Understanding and giving new meaning to realities.

 

Playing is the way the child chooses also to understand the how and why of the world, the causes and the consequences. In play, there is not one reality but every possibility which is where freedom for individual development appears. The child replays everyday events and situations and embodies different roles to discover how it may feel from an other point of view to give some sense to the behaviors others have with him. In persona play (Landy), every possible action towards significant people and themselves are portrayed including those secretly held for years. When it is too dangerous to have one's own opinion in one's family, kids can use the imaginal realm to express other ways of living or being. For example, this client, mistreated by her mother's family where she has to be the “beautiful doll one is playing with” and taken to a foster family where she is perceived as the “poor beautiful child to be saved” who suffers from feeling split between these two roles adults ask her to play. In therapy, she played the mother's role for months, feeding and fighting the kids, then became the teacher telling the mum that she “was not a so bad mother” but “I will keep your child with me” and giving a more acceptable understanding of her actual situation. I could also refer to this other child adopted by a single mum after having lived for years in a home in Haitiwith many mums and sibblings who could evoke in his play a family where one could have many mothers and try to explain his agitated behaviors by an invented filiation with a “devil” for a father who had soon disappeared from his life.

 

Giving space to imagination, expressing desires.

 

In play there is space for every forbidden desire: anger, pain, and even love can be told that could't be in the actual life. How many kids display eating (food and love) for entire sessions, how many play fighting and destroying when they don't have access to this part of themselves in actual life? In a dramatherapy group where I also use playback theatre, a teenage boy who I know quite lonely for not being involved in fights or other “male” games, told a story where he was creating a mess with an uncle in different places and then escaping the law. Landy makes the case that the aim of Drama therapy treatment is to “help people find a balance between the contradictory roles so to learn to live with their role ambivalence”. The girl I have been meeting for over two years is displaying roles of student and victim in her real school and foster family but she has been experiencing the roles of the mother, the teacher, aggressor and wife in the therapeutic space. It seems she is finding some survival possibilities through experiencing flexibility of roles and emotions that she has not been permitted in real life where the adults have imposed desires on her..... In some families, some emotions have been prohibited because they have caused trouble. A child I met had chosen hypercognitive competencies that balanced with the regressive state he displayed to maintain a relationship to his mum. In my office, he furtively expressed parts of emotions he tries to hide behind lots of distancing and rationalisation. Through puppets, he lately showed how paternal figures could appear to protect the child that may have been otherwise eaten (by the mum?); he was playing this “show” in front of me , on y desk while in talk he couldn't refer to this desire to be separated from his mother by his father who he presented as dangerous because he didn't allow him to do all what he wanted. A girl I had in individual session and who had been witness to so many violent scenes she couldn't access play, had been able to tell some of her real and many imagined life scenarios to the playback group. She displayed great pleasure seeing wedding, party or even socially prohibited actions where she was presented as part of the action. It seems she had to dream and imagine the events where she could be an actor far before having the possibility to enact something herself, trauma had removed her from her embodied possibilities...

 

 

2. The trauma

 

I will consider here trauma not only as an event but as a circumstance when reality is too hard for what the body, mind and soul can take on. In play, I have observed some behaviors that suggest they are post-traumatic reactions that have been endowed as the only way to survive at a time. Lahad talks about “dissociation in the service of survival” (p.35); therapist observe other defensive behaviors such as freezing, fighting, escaping, forgetting, transforming, ...

I met a small boy, who had grown with a mother having trouble creating bounds with him (saying she wanted a girl and having been abused herself) and the boy displaying aggressive behavior at school. One day he chose to play with masks. He chose quite frightening ones, one for each of us, and then, froze watching through the holes-eyes of the mask. He had to observe my eyes and my actions in the role he had given me and then he asked to change roles to take on the behavior I had displayed until he could evolve by himself in the role...it took him weeks to be confident enough to become active in the role. An other boy I was seeing for cognitive therapy while he was on psychostimulant treatment for his hyperactivity was ready to turn into madness instead of talking the truth: his mum was drinking and then being violent. One day, after he had been refusing any game and asking for cognitive work only, he suddenly decided to take a costume on and play his fear. I can also describe this little girl who needed to direct the game, give the roles, the places, the script and play the violent actions she has been witness or victim of. She also often displayed self agressive behaviors. She accepted one day to be directed as a mother who was giving birth and a more equal relationship appeared. As if the link between mum and child, supported by a third person -a midwife- enacted by the therapist, could help create something of the human bound that couldn't have been. In game, we can be witness of strange behaviors when the perceived reality becomes something really frightening in the mind of the child who is experiencing confusion between senses, emotions, time, places. I can recall this little girl, having accused her mum for mistreatment who started believing the tail she was wearing as a costume was going to bite her. As I am receiving many kids in foster care coming from insecure environments, I am playing with many kids “replaying aggression” with the therapist again and again until mastery of this aggressive role is reached, displayed safely and enough trust has been created to dare let go of this role and try something new. Some kids who have grown in a constant traumatic environment don't have any space for imagination, relationship with the other or pleasure, but only a repetitive pattern of organised behaviors, classifying, reproducing systems they had created, they know and can withstand. However such encounters don't answer the difficult question on the use of placement for kids in families where the relationship is complicated by life circumstances and past: “Are the abusive or neglectful effects of a dysfunctional family more damaging than the trauma of separation?” (p 151, Jennings).

 

To better understand all these type of defensive reactions we observe in play, one need to be informed on the traumatic effect on the neurobiology and the physiological consequences in terms of memory, emotions, perceptions, reactions.

When trauma intrudes the physical, cognitive and emotional processes, the body reacts in a goal of survival. Stress responses through an interactive neuro-hormonal system adrenalin-cortisol leads to very physiological responses: attack, freeze, flee. The body learns to use these survival reactions to environment reminding the traumatic event. It is association of sensory cues and reactions that are retrieved for the next threat. For example when the child has to separate in order to come to the session; when using a frightening mask, or simply the attempt to create a relationship can provoke a stress response if done too directly…When under stress, the amygdala stores a memory of the circumstances that is disconnected form the entire context ( only cues) in a matter of economy. There is no time and no way to make sense of the traumatic circumstances, no mindful representation can be elaborated at the time, there remain “free floating sensations” that overwhelm the person who didn't have control on the process (Ledoux, 1997). These memories are recorded as embodied, emotional memories that can not be treated by talk and consciousness because they are recorded at an unconscious level. It is by treating the memory through the hippocampus that it can become stored in a global context creating an episodic memory the person can have a representation of and have more mastery over. The hippocampus is affected by persisting stress and this explains why people who have experienced recurrent trauma in childhood remain more sensitive to following post traumatic reactions.

In therapy, a certain level of stress is necessary which allows plasticity of the brain and changes; however, indirect work can prevent overwhelming stress and its detrimental effects. Dramatherapy permits work on the here and now of the encounter and environment so that new associations can be made “Although the person may have a heavy load to carry as he sets out, he is given a greater opportunity to explore, re-arrange and discard that which he no longer needs “ (Winn, p.96)…This gives access to more flexible types of reactions to circumstances and creates representations that can be manipulated mentally, transformed through the experience and allow the person to go on growing. “The trauma story encoded in implicit memory systems needs to be transformed into explicit, representational form (including words) for desensitisation to occur. The method of developmental transformation allows the traumatic sense memory to be accessed, contained, represented and placed in the child's narrative past (p. 9 in James)

 

 

3. Therapeutic play - how can we help?

 

a. Where to start playing?

 

To me, our job is to start playing where the child plays, but how to assess where to start and where the child is in terms of development, play, trauma? One shall observe the child through different facets, which is not always easy while playing together…and I feel this is why the presence of a third person can be very useful.

 

 

• First of all, one should assess the notion of suffering in the child. Reaction to traumatic events are so personality-dependent that one may well be able to go over a situation that appears terrible when an other may have a hard time recover from some happening that seemed unharmful. The styles of coping to stressful situations are assessed by M LAHAD's BASIC Ph model and it is the functional coping mode that the therapist is relying on to start treatment. It has also been recognised that people who do “overreact” to an event have often been object from previous and repeated other trauma in a younger age. The new event happens to completely shake an already fragile structure.

• Where is the child in terms of his bodily possibilities? Can he be touched, can he touch the other or the material? Can he wear a mask, use props, manipulate clay or sand? This can inform on the Embodiment-projection-role development.

• Where is the child in terms of distances. Can he embody, can he quit the role? Is he cold or overwhelmed by emotions? Can he be present in the here and now and can he play in an imaginary context? Can he be himself and also play as if another? Landy evokes the “dramatic paradox” when actor and roles are at the same time separate and united and states that the reality of the existence of the actor lies in his coexistence with fictitious reality of the role he is playing”. What is the right balance for this specific child, the state where he feels good and not what the therapist judges what should be. Pendskik (2012) insists on the first “key” in her model in observing the capacity the person's show to “transcend into the imaginal realm which is congruent with a healthy mechanism that allows individual to survive trauma without developing symptoms of PTSD”. During my dramatherapy training, I met one little boy who told me after some sessions how he disliked games where we were playing with imaginary objects, this seems to bring him to a high level of anxiety. I didn't even suspect at the time that one could have such hard time entering in the imaginary world. When 'in vivo exposure is important for learning and gaining control over anxiety, ...giving the client control over the intensity of the exposure is essential” (p. 33, LAHAD)

• What are the child’s possibilities in terms of stories? Can he start, end, can he create movement through a plot? Are new emotions, new rhythms, new importance, new meaning appearing? Can he replay a same story until mastery allows a change to occur, and then dare propose change? Is it always a new story that begins, maybe talking about the same “thing”, or maybe going around the right story until it can be told? Jennings is noting that in some trauma cases, the ability for a 'real” story isn't there when only one situation climatic can be voiced as a story.

 

All these assessments are the ones that guide where to start playing with the person, the child or the child-in-the-grown-up, to catch at the place where the game capacity was left, to observe when regression appears, when changes occur, if we need to propose an other type of play that will unable the person to connect in the play.

 

 

b) How do we play together?

 

Dramatherapy seem to offer many of the tools that help work with people being traumatised and expressing it in play. Humour is something the therapist and the patient can invoke when something is impossible to be said or experienced, the same way play is spontaneously called upon when the world can not be acceptable.

The dramatherapist creates a holding environment for play: a space, things to get to the senses, different materials for projection –puppets, masks, paper, props, toys, a therapist ready to enter the dance with the patient. “Psychotherapy has to do with two people playing together” (Irwin in Weber & Haen, 2004). Irwin observes also how “make believe” strengthens boundaries between the inner and outer world and gives as a goal for the dramatherapist to facilitate imaginative play at the highest possible level so as to strengthen self control and affect regulation; help individuals put feelings and behaviors into words (Weber, p.5) . “A core aspect of the drama therapist’s work is the integration of spontaneous play and the dramatic structures of characters, plot, settings, climax, denouement, and so on”.

If it is when the child can play freely that therapy is taking place, can we teach how to play in therapy? Developmental transformations uses free play as a tool for continuous transformation. The therapist, by showing spontaneity, creativity and humor, encourages the client to continue their journey. This therapeutic space allows to retell stories under stressful enough -that triggers neuronal system's reorganisation- but acceptable circumstances to allow change. “The therapy process is by essence a fully embodied process, not just an intellectual exercise and therefore create new insights and a fresh meaning to old elements of memory, a fully integrated memory into a life story so we can move more freely into the present (Siegel, p 311). The therapeutic relationship creates a new balance of feelings-hormones –perceptions - neurotransmitters-cognition. Damasio defined “as if” as the process involving the generation of a somato-sensory image (1994) which is how one can create a separated mental object that one can perceive as not being a part of himself, giving a chance to distance and transformation. Therapy is change, Play is movement. Patience is key.

Dramatherapy also has this specificity that the therapist engages with the client in a more equal way than in other approaches. This often surprises the french people that are discovering the approach- French culture cultivates this hierarchical relationship. Encountering the client and being encountered by him is rewarding for it changes oneself each time and the sincere way we engage is rapidly ecognised by the client which engages more easily on the therapeutic journey. Irwin Yalom is proposing that we disclose at times, feeling that it is what the person needs to know about us at that moment. It is a way to approach the human with his strengths and weaknesses. It gives the rights to the client to have frailties as we do have. In play, in dramatic improvisation specifically, we take risks as the patient does, being involved with our body, emotions, and stories -t hat we have been working on to be able to separate our processes from the client's (Goodyear-Brown, p.195). Surely, we put more on the stage than one does in more traditional therapy, but again, when one is coming from trauma, what more important than meeting really with someone on the stage of life?

 

 

For Berger (In Joly, p.140), psychoanalytic approach gives three types of frame when working in play: “préoccupation coined by Bion”, which is being concerned which helps the child bind his thoughts; play with the other and his ideas; and interpretation when play is interpreted as a dream.

While it is the past that has made what we are and when people come to therapy so that future may be better, it is the specific working on the here and now that allows change to occur during the therapeutic encounter. Something is happening for real. Some dramatherapists include the concept of mindfulness in their work, and in post traumatic stress disorder as well as other pathological conditions, this approach seems to show positive effects. Siegel explains that “the acceptance of one's situation can alleviate the internal battle that may emerge when expectations of how life should be do not match how life is (p. 19)”. Specifically, this special attention we give the child when we are playing together is possible only if we are really engaged in the process in terms of emotions, cognitions, actions, linking with past, foreseeing some of the future of the story played (even if the child chooses other directions), and this requires a strong attunement to the child's state of being. For Siegel, it is this attunement to the patient that” alters the self regulatory integrative fibers of the brain”. Integration is something key in treatment since one of the goal in traumatherapy may be to help the person reassociate emotions, perceptions, cognitions, memories, sensations in a new and more acceptable way. In a long enabling process, the therapist helps the client to consciously reconnect to the bodily sensations, to reunite the five sensorial factors of the experience and to overcome the freeze reaction. These components are sensations, imagery, behavior, affect and meaning. We propose to use fantastic reality in treatment in re-narration of the trauma” (p 38-41, LAHAD). The phase where we offer total listening to the child is a necessary long period before he is able to become mindful and attuned to himself. When this occurs, independence emerges and therapy starts ending. In dramatherapy, when getting to play with the person, we particularly permit narrative integration (Siegel, p.307, Goodyear-Brown, p.250) since we have to get the story very deeply and not only become a receiver and a memory thread but we are coparticipating often to the process. Some of the kids do remember the story exactly were they stopped it during the previous session even months later, and they kind of expect me to be able to catch the way they do. Many need also to see that their story gets written all along as a solid proof that it has existed and is part of reality not only in their mind but in the social mind through this social written process.

Having been confronted to different kinds of therapeutic approaches, I believe dramatherapy really represents an approach where the therapist works on leading the client to draw his own meaningful world where he can bear on living. As difficult as this is, one has to admit that peace of mind and well being reside in a very different place for everybody. The task is even more uneasy in allowing another to be well where oneself would not be. This is true for respecting the rhythm of change -or no change- when the client finds it more expensive to change than to do with his actual troubles. Other times we may even be upset to see that some “pathological” ways of living are the one chosen by others: risk taking, dependent relationships, psychosomatic symptoms, agitation or repetitive behaviors may all be ways a person chooses. Indeed they get some satisfying consequences that counterbalance enough the “pathology”. What are we doing in therapy? Can we “allow” them to live without guilt or social dissatisfaction for having chosen to stay with their “unhealthy” habit?(Yrvin Yalom).

 

 

 

Conclusion

 

Play is a process very parallel to the lively processes structuring the person. And everyone has a different relationship to play as everyone has used different adaptive processes to answer their life stories. But when trauma comes to create a break in the flow of one's story, play can be a way to bridge the gate and specifically offer a space out of everyday's space to have the possibility to transform something of the story. This requires lots of humility as a therapist since playing together is a very unknown process that cannot be planified and where both partners open themselves to discover, adapt, and go on the journey. I specifically want to thank the patients that accept we dance together in our stories...

 

 

Bibliography

 

Goodyear-Brown, P. (2010). Play Therapy with Traumatized Children. A prescriptive approach. Wiley.

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