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Childhood Trauma: Developmentally Appropriate and Trauma-Informed Interventions

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While much of psychotherapy is prescriptive in nature—whether led by theoretical or technical reasons or perhaps directed by practice standards or managed care—the need to consider developmental factors remains imperative. Unfortunately, this often seems to get lost in working with children, particularly traumatized children.

Consider this. A child engages in their world, terrified because they have been traumatized. Perhaps the adults in their life know about it, perhaps not. Regardless, the child is exhibiting a symptomatic response. The surrounding adults know that professional support is needed. A referral for therapy is made. It is time for a trauma intervention. Many therapists have been trained and are experienced, but most likely with adult clients. However, are children that much different? Yes, incredibly different.

While I would agree with most therapists that the trauma narrative must be expressed and processed—how this is accomplished is where I find myself at odds with some child therapists. Expressing the pain does not need to involve verbalization. In fact, I would argue that compelling this with child trauma clients is often damaging. As an expressive/play therapist, I will use nonverbally-based interventions with most traumatized clients, and always with children. There are basic developmental, psychological, neurological, and scriptural reasons for this perspective.

Children lack the developmental, cognitive, and abstract thinking skills to engage in “adult therapy.” Whereas we process verbally with words, children do not have this ability. Even verbally precocious children lack adult cognitive abilities, which can lead child therapists to mistakenly engage exclusively with spoken interactions. 

My contentions should, by all means, not discourage us from working therapeutically with children. I believe play therapy is the developmentally appropriate restorative interaction with child trauma clients—actually all child clients. Children actually do “talk” in play therapy. However, in their case, play is the language and toys are the words (Landreth, 2012). Although my perspective is not to interpret the story but rather to witness their story—a fellow sojourner on the therapeutic journey. This is a goal of mine with trauma clients of any age.


Why Expressive Therapy?

It is important to consider my basic rationale for play and expressive therapies. In Sweeney (1997), Homeyer and Sweeney (2017), and Sweeney and Lowen (2018), several are offered:

  • As previously mentioned, play is simply the child’s natural medium of communication, as opposed to verbal communication, which is the primary medium of “adult therapy.” I would argue it is unfair and dishonoring to expect children to leave their world of expressive play and enter the adult world of verbal communication. After all, empathy involves entering the client’s world.
  • Expressive therapies inherently have a unique kinesthetic quality. Play and expressive media provide an unparalleled sensory experience, which meets a basic need that I believe all people have for kinesthetic experiences. 
  • Play and expressive therapies create the necessary therapeutic distance often needed for traumatized clients. While these clients may be unable to express their pain in words, they can find expression through projective media. 
  • This therapeutic distance then creates a safe environment for abreaction to occur. Traumatized clients need a therapeutic setting to abreact—a place of safety where painful issues can emerge and be relived—thus, a safe place to experience the intense negative emotions that are often attached to traumatic experiences.
  • Play and expressive therapies create a place for traumatized clients to experience control. I believe that a fundamental result of traumatizing experiences is a loss of control for those in its grip. A crucial goal for these clients must be empowerment, recognizing that the loss of control inherent in trauma and chaos is intrinsically disempowering. 
  • Expressive and play therapies provide a unique and natural setting for the emergence of therapeutic metaphors. The most powerful metaphors in treatment are generated by clients themselves (as opposed to those orchestrated by therapists), and expressive therapy creates an ideal environment for this to occur. 
  • Play and expressive therapies are effective interventions for traumatized clients in light of neurobiological issues. Potential neurobiological inhibitions on cognitive processing and verbalization contend for the benefits of expressive intervention.