My Perfect World: A Day in the Life of a Child Therapist

By Karen LeVasseur, LCSW, owner and therapist at Calm4Kids Therapy Center, LLC

Imagine a world where you spend all day playing. Perhaps you would shoot hoops or play hockey. Or you might dress up your dolls or blow bubbles. Maybe you would paint a picture or play board games. When you tire of playing and need a break, you could spend time resting in your bean bag chair or relaxing in your very own tent. Sounds perfect right? Luckily for me, this IS my world… the world of a child therapist.

As a Clinical Social Worker I work with children between the ages of 3 and 18, supporting the occasional adult as well. Treatment options vary from client to client with most parents seeking either play therapy or hypnotherapy for their child. Regardless of the modality of treatment used, therapy is fun! When my “friends” come to my playroom they know they are in a safe and peaceful place, where they can try out new things, make mistakes (and be okay with it) overcome obstacles and feel good about themselves. The kids I work with are not treated as damaged or impaired; they simply practice new skills and strategies that help them feel happier and overcome obstacles to success.

What might a typical therapy session look like? Sessions are structured in a way that allows predictability for my young clients; many of whom are diagnosed with ADHD or Autism. We have a brief “Check-in” to talk about the events of the week; engaging in problem solving or goal setting as needed. Next comes “Pick 4” with the child selecting four calming or mindfulness strategies to practice. Then comes the meat of the session where we work on the presenting problem.

In a recent session, with a 3-year-old I will call Sam, we engaged in play therapy to address issues with self-concept. Sam, who is typically a sweet, gentle boy, considered himself a bad boy after becoming physically aggressive with another child at his pre-school who had been hitting, kicking and biting him. He showed signs of anxiety through crying, clinging to mom and refusing to go to school. In the initial session, Sam started a game of “Good Guys, Bad Guys” using my toy Super Heroes (the good guys) and dinosaurs (the bad guys). In the game, the purpose shifted from session to session, with the good guys becoming bad, the bad guys becoming good, everyone fighting etc. One session stands out as the most pivotal moment in his treatment. Sam became very serious and told Superman (the figure I was playing with) that he needed to tell him something. He leaned in and whispered “I’m not always a good guy. Sometimes I fight.” Superman, who is very wise and loves to help kids, told him “When I was a little boy sometimes I got into fights at school. I thought I was a bad boy, but my mommy told me something very important.” I could see the wheels in Sam’s head turning as he waited for Superman to share Supermom’s wisdom. “Everyone makes mistakes with their behavior,” Superman said. “But they are still good kids”. Sam thought about this for a moment, nodded his head, and the game was done. He had “played out” his issue. In play therapy, the act of playing is the child’s language and toys are the child’s words. In the therapeutic setting, children learn to communicate with others, express feelings, modify behavior, develop problem-solving skills and, as in Sam’s case, resolve inner conflicts; all through play. Sam and I have played “Good Guys, Bad Guys” a few more times since, but the focus has changed to the good guys helping the bad guys and everyone ending up as friends.

Play Therapy

Another notable session involved the use of hypnotherapy with an 11-year-old I will call Amy. Our work together has focused mainly on anxiety related to social relationships. When she came in for a recent session, she was visibly upset, describing something that had happened at school that day. One of her longtime friends had given her “the look” at recess, then laughed and ran away. Other girls became involved and when Amy tried to stick up for herself the other girl told her she was over-reacting. This may seem inconsequential to an adult, but in the tween world an event like this is DEVASTATING! We talked through the situation, identifying the worst part of it, which was Amy’s fear that all of the girls would turn against her. We engaged in role-play to explore different ways to handle the situation if it continued the next day. Then we ended the session with hypnosis to strengthen her confidence and imagine handling future drama successfully.  Hypnosis is a wonderful tool to use in therapy as it encourages use of the imagination. According to the American Society for Clinical Hypnosis, mental imagery is very powerful, especially in a state of focused inward attention. The mind is able to use imagery to assist in promoting change in thoughts and behaviors. Ideas or suggestion that are congruent with the child’s needs are given, and in a state of concentrated attention, this can have a powerful effect on the mind. The next session Amy reported communicating with her friend confidently and assertively and working out the problem between them.

Clinical Hypnosis

Providing therapy for a child who is struggling is very important. Through the therapeutic relationship my “friends” are able to express themselves without consequence, explore the reasons for their behaviors, learn to shift negative thought patterns and manage their emotions; thus allowing for greater confidence and an increased ability to manage daily stressors. What do I get out of my work? Well, unbelievably I get paid to play all day (Remember that perfect world?) But, more-so, I have the opportunity to connect in a positive way with kids and make a difference in their lives. And that is priceless.

Kids Mental Health Informational Portal

Karen LeVasseur is an LCSW and is owner and operator of Calm4Kids Therapy Center, LLC in Bradley Beach, NJ where she offers hypnotherapy, play therapy, EFT, and mindfulness based psychotherapy for clients ages 3 through adult. Karen also has vast experience as a School Counselor, Elementary School Teacher, School Social Worker and School Anti-Bullying Specialist. Karen’s website and Facebook page offer more information about her practice.

Sources/Citations

Photos from http://www.pixabay.com

Websites: Association for Play Therapy http://www.a4pt.org/

                American Society of Clinical Hypnosis http://www.asch.org

Building a Culture of Caring in Your Classroom

By Karen LeVasseur, LCSW, owner and therapist at Calm4Kids Therapy Center, LLC

Building Character

Having worked as an elementary school teacher for many years I know the importance of building character in your classroom. I learned over the years that time spent on character education, in particular at the beginning of the school year, was time well spent. Think about it. To engage successfully in academic learning, the following skills need to be in place:

- Emotional regulation

- Problem solving

- Communication

- Teamwork

Students don't always come to school with the skills that they need and it is up to the educator to support kids in learning the "how" of getting through their school day. If you have ever read The First Six Weeks of School by Paula Denton and Roxanne Kriete, you will agree that spending time at the beginning of the school year, setting expectations, modeling and practicing socially acceptable behaviors, establishing a routine for identifying and resolving conflict and solving problems as a team will set up your students for success and allow your classroom to run like a well oiled machine. 

Setting Kids Up For Success

I remember one year, when I taught fifth grade. I was excited for the year, having been in fourth grade for many years. I was eager to dive into the fifth grade curriculum and set up a great academic program for my kids. Unfortunately, the twenty five youngsters in my class were not as excited as I was. The school year started off with problem behaviors, arguments, yelling, teasing... It was not the happy school year I had envisioned. About three weeks in, I brought academics to a screeching halt and put a heavy emphasis on character building. During the next month and a half I started holding a morning meeting each day, used the time right after recess for meditation and created an "Acts of Kindness" Wall. Everything we did academically involved practicing team-building and problem solving skills and assertive communication. By the end of October, my students not only knew what to expect and what to do, they also knew how to do it well. My well oiled machine was achieved!

Morning Meeting

Holding a morning meeting is an important part of your classroom culture. Starting each day as a community, interacting positively with one another is a great way to start off the day on the right foot, for students and for the teacher! There are many different activities you can incorporate into your morning meeting. Be creative and add activities that feel right for you and for your kids. Some ideas include:

Class Pledge- Write a pledge that speaks to the core values you want at work in your class. An example is "I pledge allegiance to my class, that I will try my best, to make good choices and try real hard to be responsible like the rest. I care about the others here and I care about me. I want school to be a special place where I learn and want to be!"

Greetings- One year I taught my students to greet one another using both Spanish and American Sign Language. Students would pair off and say/sign "Good morning, how are you?" The student would respond with "Good morning, I am (happy, mad, tired, sick...). How are you?" The kids loved the bilingual challenge!

Circle of Friends- Ask your students to sit in a circle either on the floor or in chairs. Pose a question such as "How will you be successful today?" or pose a challenge such as "Compliment the person next to you on something nice they did yesterday" and have each student respond. Emphasize active listening skills and use a talking stick if needed.

Problem Solving Box- Set up a box in the classroom with problem sheets that students can fill out indicating the following: I have a problem with... It is a problem because... I have tried to solve it by.... Each morning pull out one problem sheet and read it to the class. Allow the kids to generate possible solutions to the problem. The person who wrote the sheet can remain anonymous or they can identify themselves. Either way, the child with the problem will leave the circle with many new ideas to try!

Minute to Win It- Put kids into pairs and give them a 60 second challenge to complete together. Use riddles, math problems, rebus puzzles or have them complete a physical or building task like on the tv show. Allow the students to be noisy and have fun while they build teamwork skills!

Calm Kids are Productive Kids

I think one of the best decisions I ever made as a teacher was to add meditation to my schedule. I have used the technique at different times of the day but found that right after recess really helped kids to recharge and refocus, allowing success for the second half of the day. The meditation does not have to be long. Even a few minutes of mindfulness to breath and stillness can calm an active or emotionally labile child allowing them to make good choices with their behavior and with peer interaction. Try some of these techniques. I'm sure you will notice a difference in your students' affect as well as your own!

60 Second Vacation- Have the kids lay on the floor or relax in their seats. Ask them to close their eyes and imagine a place where they feel happy, calm and safe. Guide them in using their senses to explore this place, envisioning themselves doing something to be focused, calm and successful. After about 60 seconds of quiet visualization and deep breathing refocus students on the classroom environment and their job as a student.

A Moment of Stillness- Have kids relax as above and guide them in taking slow, deep breaths (belly breaths) filling up their lungs and expanding their abdomen like a balloon on the in breath, then releasing on the out breath. Once a breathing pattern has been established, ask the kids to continue breathing, remaining as still as possible for a minute of meditation. It is helpful to have them imagine sinking into their chair or melting into the floor. When time is up ask the kids to open their eyes and focus on your face (or a point in the room), taking one more cleansing breath.

Breathing Buddies- Students lay on their back on the floor with a small stuffed animal on their bellies. This is called their breathing buddy who helps them learn to take belly breaths as described above. Model for students how to take a belly breath, saying "On the in breath the belly goes out and on the out breath the belly goes in." Guide students in taking slow, deep belly breaths for a few minutes then collect the buddies and get back to work feeling refreshed!

Meditation for Kids

Meditation For Kids: Parents Turn To Mindfulness Practices To Help Children Stay Calm

Being Kind is Cool!

It is helpful to teach kids the importance of being kind and caring toward others. I helped my students learn this valuable lesson by first identifying acts of kindness in literature, providing roleplay scenarios and by inviting the "Note Fairy" to visit my classroom (she secretly leaves notes for students who she witnessed acting kindly toward others). Once the term "Act of Kindness" was well understood and students were regularly engaging in AoK's I set up an "Acts of Kindness" Wall where students could note the kindness of others or post their note from the Note Fairy to celebrate their own success. Each week a different student was honored on the wall with a brief description of how he/she went above and beyond in helping our classroom be a kind and caring environment. Regular celebration of success really helped to motivate kids to be kind to others and to themselves!

Random Acts of Kindness

Welcome | Random Acts of Kindness
Kindness stories, quotes, ideas, classroom resources and more.

Try some of these ideas and please share the wonderful things you do in your classroom! Be creative, have fun and remember, "What you notice will happen more!" Celebrate your students' successes and help them to build the skills they need to be able to add to the culture of caring you have established in your classroom.

Karen LeVasseur is an LCSW and is owner and operator of Calm4Kids Therapy Center, LLC in Bradley Beach, NJ where she offers hypnotherapy, play therapy, EFT, and mindfulness based psychotherapy for clients ages 3 through adult. Karen also has vast experience as a School Counselor, Elementary School Teacher, School Social Worker and School Anti-Bullying Specialist.

Occupational Therapy: A New Frontier in Healthcare

by B. Lana Guggenheim

Occupational therapy is often confused for other therapies, such as physical therapy. But while occupational therapy does sometimes make use of medical and physical therapies, its practice encompasses a much wider series of activities and healthcare prerogatives.

Physical therapy is a highly specific medical profession and series of practices focusing on a patient’s abilities to move and perform functions. Occupational therapy can and does encompass this, but its focus is on the daily work and life skills of a patient. As such, it covers not just physical capabilities, but mental and cognitive disorders, and other barriers, both physical and environmental, to a patient’s independence. Occupational therapy is inherently interdisciplinary, drawing from psychology, medical science, and social work.

Both physical and occupational therapies have their roots in ancient medical practices like massage and hydrotherapy advocated by physicians including Hippocrates and Galen. But the earliest evidence of using occupations as a therapy method (occupations meaning activities that occupy a person’s time, rather than paid labor) was by the Greek physician Asclepiades in 100 BCE, who advocated humane treatment of patients with mental illness using baths, massages, exercise and music - practices which had been dropped by medieval times, only to be revived in the past two centuries.

Modern physical therapy was established as a discipline towards the end of the 19th century in response to polio and World War I, which increased global demand for such aid. However, occupational therapy began as part of an 18th century hospital reform by French revolutionaries Philippe Pinel and Johann Christian Reil, using work and leisure activities as part of patient therapies. This was part of something called “Moral Treatment,” an Enlightenment-era philosophy that approached mental illness with humane care, derived both from the emerging science of psychology, as well as moral and religious mores. This led to the rise of asylums, which only declined in use in the 20th century. The Arts and Crafts movement of the late 19th and early 20th century also impacted occupational therapy, as it emerged as a form of human occupation and creativity in the face of loss of autonomy and monotony found in increasingly common factory work, as well as staving off boredom for those confined to long hospital stays, whether that was due to mental illness or physical malady. By the early 1900s, occupational therapy was becoming professionalized, challenging the mainstream views of scientific medicine by being inherently interdisciplinary, incorporating social and economic understandings with medical principles.

Reconstruction aides, an umbrella term for both occupational and physical therapists during World War I, most of whom were women, were very successful. Post-war, in order to keep people interested in the profession, emphasis shifted from war-time altruism to the financial and professional satisfaction of being a therapist, and practice and curriculum were standardized, and the profession obtained medical legitimacy in the 1920s. Today, one requires a minimum of a Master’s degree to practice in the field, but increasingly there are doctorate programs and research avenues opening up as well. Occupational therapy is increasingly focused on a patient’s mental health and in treating mental illness.

Ultimately, the two core principles underlying occupation therapy are the centrality of occupations as a basic human need, bringing meaning to life culturally and personally, and thus is therapeutic, and the concept of holism, indicating that a person and their health can only be properly understood in concept of their larger social environment. Occupational therapy grew out of practical applications of psychology and healthcare practice, but there is an increasing emphasis on research, and occupational science, the study of people as occupational beings, was founded in 1989 as a way to provide evidence-based research to support and advance occupational therapy. Occupational science underlines the ability of people to pursue occupations, specific activities that give their lives structure and meaning. While still young, there are increasing numbers of programs offering doctoral degrees in this emerging social science.

Occupational science understands occupations as an antidote to psychological pain, offering structure and means to find meaning in people’s lives. It influences patients’ health, self-respect, and sense of dignity. It is not so much the specific activities undertaken, so much as that the activities chosen are laden with symbolic meaning, thus making occupation a uniquely human enterprise, a point of human experience mostly ignored by other social sciences, and critically important particularly to the development of occupational therapy. Only once the place and potency of a given occupation, defined as culturally and personally meaningful human activity, in a person’s life is understood can therapies be tailored to their needs.

Occupation therefore encompasses much more than just paid labour, but hobbies, habits, personal rituals, or cultural activities as well. Many occupations are not productive, but primarily pleasurable, as their purpose is to imbue meaning and carry some sort of symbolism rather than material benefit. And research has indicated that mundane, daily activities affect psychological well-being far greater than major life events, meaning that the ramifications of a person orchestrating and organizing their daily lives and engaging in occupations are significant, particularly because unlike animals, human activity requires self-awareness, memory, planning, and engaging in layers of personal and cultural meanings.

Occupational science however addresses both these, as well as neurobiology and physical health. The USC Department of Occupational Therapy developed a Model of Human Subsystems that Influence Occupation to provide a conceptual framework by which all these factors interact and influence a person’s development. The model depicts a human as an occupational being, seen as an open system in interaction with their environment over the course of their life. The use of the systems model, here consisting of six substrates, explain developmental changes in a person over the course of their life is consistent with developmental psychology, of which in this case, a chosen occupation is the output.

These systems allow occupational scientists to examine how a person makes sense of their life via their chosen activities, within the context in which they function and its significance to the individual in question, which in turn requires a synthesis of knowledge from the biological and social sciences. This model allows it to function as a blueprint to organize the research and findings of faculty, students, and practitioners into a unified corpus of knowledge. The applications of this new science, while born from occupational therapy, will apply far beyond it to other disciplines, though both are empowered by the same values, namely the central role that occupation plays in health and life happiness, and viewing a person as an active agent in their own life.

This is important for keeping occupational therapy practices on track, as some worry that it was becoming over-focused on acute care instead of helping patients, especially the disabled or those with chronic disease, improve life opportunities and ability. Instead, therapists are seen as “treatment machines” and patients as “products” to be displayed on a balance sheet. If one’s identity isn’t taken into account except superficially, any therapies are not going to be as effective as they might, especially because many patients are navigating a transition from their old lives to a life with new parameters and limitations. One’s occupations allow a patient to bridge that gap and provide a framework for adaptation and recovery. Occupational science can help occupational therapists aid patients in internalizing this aspect into their clinical reasoning and therapies, helping nurture the human spirit as well as the human body.

Works Cited

Clark, Florence A., Diane Parham, Michael E. Carson, Gelya Frank, Jeanne Jackson, Doris Pierce, Robert J. Wolfe, and Ruth Zemke. "Occupational Science: Academic Innovation in the Service of Occupational Therapy's Future." The American Journal of Occupational Therapy 45.4 (1991): 300-10. Web. 21 Apr. 2016.

Clark, Florence. "Occupation Embedded in a Real Life: Interweaving Occupational Science and Occupational Therapy." American Journal of Occupational Therapy 47 (1993): 1067-078. Web.

"The History Of Occupational Therapy." The History Of Occupational Therapy. N.p., n.d. Web. 21 Apr. 2016.

Jackson, Linda. "The New Research Climate Surrounding Occupational Therapy." The Guardian. Guardian News and Media, 27 Jan. 2015. Web. 21 Apr. 2016.

Saving American Families: Marriage & Family Therapists in Action

As you very well know, this Thursday the United States celebrates Thanksgiving, but that isn't the only celebration happening this week. November 22 - 28, 2015 is also National Family Week, an annual tradition dating back more than 40 years. During this special week, Americans across the country & world will be reuniting with family to share meals, stories, fun & games. We here at Enky want to take the time this week to honor some very special professionals who help the families & couples of America get through some of the most challenging times of their lives together: Marriage & Family Therapists (MFTs).

These mental health professionals are the ones we turn to when communication breaks down in our relationships, when we suffer terrible loss & have trouble moving forward, and when we just need someone to talk to about whatever is bothering us in the context of our family or relationship. Marriage and family therapists treat a wide range of serious clinical problems including depression, marital problems, anxiety, individual psychological problems, and child-parent problems. They frequently work in group settings, where a couple or a family unit would come in for counseling together, although some MFTs do individual sessions as well. MFTs are highly trained professionals; they all must complete at least a Master's degree in the field, and many either complete Doctoral degrees or other post-graduate clinical work. The average Marriage & Family Therapist has 13 years of clinical experience in the field, so many of these therapists are quite practiced at the art of helping families through difficult challenges.

However, this does not mean there are no opportunities in the profession; quite the opposite in fact, as marriage & family therapy is projected to grow at a rate of over 30% from 2012 - 2022 according to the US Bureau of Labor Statistics, whereas the US average occupation is only slated to grow at 11% for the same period. As the stigma around both mental illness in general & seeing counselors & therapists specifically decreases in American society, more & more people will be visiting MFTs each year. So remember this during your Thanksgiving meal when your spouse, sibling, or parent has inevitably gotten on your nerves: Marriage & Family Therapists are always there waiting to help you & your family recover from the most difficult challenges you will face.

Be sure to check out our helpful infographic below, which is chock full of statistics & other facts to teach you more about the profession of Marriage & Family Therapy & keep coming back to this blog & our social media pages all this week for more MFT focused content!!

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Massage Therapy: Refreshing the Body & Mind

Thanks for coming on back to the Enky Inc. blog! To recognize National Massage Therapy Awareness Week, we're focusing on Massage Therapy for our Profession of the Week. Massage therapists help millions of people each year cope with pain & stress, both physical & mental. Massages can be used to treat back & joint pain, trouble sleeping, depression & anxiety, as well as lower blood pressure & heart rate. Massage therapists are a diverse group of professionals, as there are many different career paths to follow within the massage therapy field. Many of these professionals are self-employed, while others work in medical practices or massage franchises that have become widespread in the US. The profession is growing at an extremely rapid rate, with the US Bureau of Labor Statistics forecasting a 23% increase in jobs in the field between 2012 & 2022 (the average growth for all professions over this period is 11%). Compared to other healthcare professions, massage therapy is relatively easy to learn; most states that require licensing for massage make professionals take between 500 & 1,000 hours of training, which is comparatively low. Massage therapy is also a flexible profession, with over 60% of therapists working a part-time schedule. This, combined with the large number of self-employed massage therapists, allows for professionals in the field to practice their profession on their own terms while still earning money & providing a valuable, in-demand service. Check out the infographic below for more info about this exciting & accessible profession & keep coming back to this blog & our social media pages this week to find out more about Massage Therapy!

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