I have a basket of miscellaneous toys on my shelf and the kids like to rummage through them. Most popular are the real cell phones even though they’re not smart phones. The kids really like the ones that slide out so they can “text”. There’s also a magic wand, some rubber balls and a toy gun. Toy guns in play therapy aren’t as controversial as, say, toy guns in preschool but they are still part of an ongoing discussion that play therapists have with each other.
We all agree that a fully stocked play therapy office needs to include some ways to be aggressive like rubber swords, dragon puppets, lion figurines or guns. Most of us are ok with guns and some of us are not. We have different ideas about what kinds of guns can be used (at the agency where I used to work we had Nerf-type guns that shot spongy “bullets”) and we have different rules about how they can be used (some therapists don’t allow kids to point a gun at the therapist and some do — my decision depends on context).
The gun I have looks an awful lot like the cowgirl cap gun my mom bought me from Sears to go with my red-with-white-fringes cowgirl Halloween costume. I think that was 1975 so this one is a little different — it has more plastic, less metal and it has the orange tip that they started adding to toys in 1992.
I chose this gun because it is so clearly a toy. It doesn’t look like a modern gun (it isn’t black, you have to cock it) and it doesn’t actually shoot anything. Lemme tell you, I got really tired of helping kids dig under chairs for those spongy yellow “bullets” so when I set up my own office I decided no Nerf-type guns.
Some kids are very excited when they find the toy gun. Other kids don’t care one way or the other. Very, very occasionally a child will tell me that he or she is not allowed to play with toy guns and ask me to remove it and of course I always respect this request and we talk about that.
My decision to allow toy guns in my play therapy office is indicative of my belief that kids should have a full vocabulary in the language of play. As a mother I struggled with gun play and it was something my friends and I discussed at length. We all fell on different sides of the decision — some of our kids had full arsenals and some weren’t even allowed to play with figurines that had guns attached to their tiny hands — but we all thought about it a lot. Other weapons like swords, knives, and bows and arrows didn’t cause us as much concern. I suppose there are vestiges of this struggle in my decision to use an anachronistic cowboy gun in my play therapy room. But I never considered not having a gun available to my clients.
Kids are smart. They get that the play therapy office is different then the rest of the world. They understand that the rules I have aren’t the same as the rules that their parents or their teachers have. Children who aren’t allowed to use guns in the rest of their lives but who welcome the one in my basket are OK with leaving it there when they go. (Although they are usually super excited about showing it to their parents — sometimes they even run out to the waiting room with it when they find it!)
Some of the children I work with use the toy gun to work out feelings of helplessness or power by shooting my stuffed dragon or the picture of the guy doing a handstand on a horse that hangs above my couch. Some of them don’t use it at all but keep it near them while they work in the sand tray or color; having the gun nearby makes them feel safe.
Sometimes children shoot my Feelings poster (a grid of pictures featuring kids making faces to illustrate different emotions) often as an indicator of their own frustration at their inability to understand or name their own feelings.
Sometimes kids tell me who they would like to shoot or announce that they’re shooting someone while they aim into the middle distance. This can be upsetting for parents to witness but I liken it to an adult saying in my office, “I could kill my boss!” or “I wanted to throttle my brother-in-law!”
Often children just want to use the gun because they think it’s fun. This includes both the kids who can play with guns at home and those who aren’t allowed to. Some of them include it in their play because it’s part of a language that’s familiar to them. Others use it because it’s novel and they’re excited to explore. Many, many children glance at the gun, cock it and pull the trigger a couple of times and then put it back never to play with it again.
Frankly the cell phones are way more popular.
If you bring your child to see me and have concerns about the gun or any other toys I have in the playroom, I encourage you to bring it up.
Parental involvement is a key ingredient in kid client success in therapy. What this looks like will depend on your child and his/her treatment plan, your practical ability to be involved (are you a noncustodial parent? Is your child receiving services at school?) and the therapist. But at the very least, you and your child’s therapist should be communicating regularly.
Depending on the child, the parents and the treatment goals, I include parents in the following ways:
- Parents attend sessions with their child (this is common with young children and with children who are struggling with attachment);
- Parents come in for the first or last few minutes of session;
- Meeting with parents separately before or after the child’s session;
- Scheduling separate sessions with parents when needed and appropriate;
- Arranging for phone calls to check in.
I like kid feedback for how parents should be involved, particularly with teenagers who are navigating the developmentally appropriate need to separate along with the necessary support from parents. Sometimes this means helping the teen figure out how they want to talk to parents about something and then inviting parents to session to help mediate a discussion.
I go over confidentiality with parents and teens in session with the understanding that we will all respect the teen’s privacy in the counseling relationship but that the adults will keep her safety paramount in decision-making around what to share. When kids are struggling in a gray area, I always encourage them to invite parents to the discussion but I won’t go over their heads and tell secrets unless I’m concerned for their safety.
Here’s the Ohio ACLU publication about minors and their rights. The part about counseling (this is a PDF file) starts at page 40: Your Health and the Law: A Guide for Teens.
From the file:
A minor who is at least 14 years old can request outpatient care without notifying a parent as long as the treatment does not include medication. However, such care is limited to six sessions or 30 days, whichever comes first. After that, the care must stop or the parents must be informed and must consent in order for treatment to continue. During the first six sessions or 30 days, the parents will not be informed of the treatment unless the teen consents or the care provider feels the minor is likely to harm someone. Still, before the parents can be informed, the care provider must first tell the teen that the parents will be notified.
I have not had a teen call and ask for counseling on her own but I have had other loving adults (relatives or family friends) call me to find out if they can bring the teen to counseling without parental consent. I always explain how the law works and explain that except in cases where parental involvement would be dangerous to the child, it’s really best to have parents be a part of counseling.
There are guidelines around counseling teens and maintaining confidentiality. As a counselor practicing in Ohio, my ethical guidelines come from Ohio’s Counselor, Social Worker, and Marriage and Family Therapist board and my professional organization, the American Counseling Association. Both these entities recognize that teen confidentiality is a gray area. The ACA and their sister organizations for social workers and other therapists regularly publish articles and papers on the topic.
Here’s a handful for you to check out:
As you can see, there are not definitive answers because these topics are complex and so very individual. How I might, for example, handle it if a client tells me s/he is sexually active will depend on many things including but not limited to:
- Why the teen is in counseling in the first place;
- With whom they are being sexually active (is it consensual? Is it legal?);
- How old the teen is (there’s a big difference between a 13 year old and a 17 year old);
- The family’s values around sexual activity;
- The circumstances surrounding the sexual activity (are there pressing concerns about safety?).
My first priority is always first and foremost safety but I recognize my ideas about safety may be different than the families. For example, say I learn that a 17-year old after careful consideration and planning decides to access birth control and have sex with her long-term partner. Perhaps she comes from a strict, conservative family whose religious beliefs condemn premarital sex. I am unlikely to break confidentiality under those circumstances.
I say this to encourage parents to talk to their teen’s counselor to make sure that they understand each other. If you want a counselor who would break confidentiality then I’m not the right person to work with your teen. It’s best we all know this ahead of time.
That said, I do not ever encourage teens to lie and I do not side with them against parents.
Finally, when confronted with a sticky situation I seek supervision, meaning I go to my peers and my mentors to get feedback when I’m not sure. While maintaining confidentiality about the individual and the family, I ask for help and document these efforts accordingly. It’s dangerous for any therapist to operate in a vacuum and I am fortunate to have great counselors available to me to answer questions and help me examine ethical practice as it applies to the complicated reality that is counseling kids and teens.
At the anxiety workshop we talked a lot about what’s normal and what isn’t normal and needs intervention. Sometimes it’s clear — your child absolutely refuses to go to school or your teen tells you she’s depressed and is thinking about hurting herself. But other times it’s more ambivalent. Are these tantrums normal? Is your reaction to them making things worse? Can counseling help your 7-year old’s struggles in school?
Here’s how to figure it out.
Are you or your child missing out?
Is the issue — sadness, anxiety, anger — getting in the way of your everyday lives? Do you find yourself spending more and more time trying to move from one place to another? Is she expressing frustration or sadness with how things are going? Are you?
This is the number one way to know that it’s time to get help. If you or your child are avoiding things, if the problem is disrupting the normal events in your lives, that’s the very definition of troubled. It’s one thing to be scared of dogs; it’s another thing to be so scared of dogs that your child won’t leave the house. It’s one thing to want to stay home from second grade; it’s another thing to scream and hold onto the door frame when your dad tries to move you out the door to the bus stop. It’s one thing to have a lousy day where your child falls apart at the zoo; it’s another thing when you can’t go to the grocery store because of your child’s tantrums in the cereal aisle.
If you find yourself living around your child’s challenges, it’s time to get help.
Are you at your wit’s end?
Do you dread confronting your child or dealing with transitions? Do you find yourself unhappy with your child more often than not? Are you losing sleep because you’re worried about her? Do you find yourself asking friends, relatives, strangers for advice?
Parenting is no endless ball of fun but most of the time it’s pretty good. We can all have bad days and even bad weeks but if you aren’t enjoying your child and your child isn’t enjoying you, you both deserve help. Parenting is hard but it shouldn’t be so hard that you find yourself crying or yelling at the end of the day. Counseling can help you have fun being a parent again.
Are other people expressing concern?
Is your child’s teacher sending lots of notes home? Are there people you trust who are worried? Do you find yourself constantly defending your child?
Sometimes other people can see what we can’t. I’m not saying that every kid who’s not clicking with her teacher needs help but if the teacher’s concerns ring true or she’s the last in a line of concerned people, it might be time to get a new perspective. If you’re not sure — is your mother-in-law’s criticism valid or not? — a counselor can help you figure it out.
It’s hard to know when we can handle what’s happening for our kids and when we need professional help. Fortunately you can call a therapist and ask her. Does this sound like a concern? How will I know when it is? What might it look like if we come in right now? Further, you can get help simply because you want it. If you use your insurance to pay for counseling you (or your child) will need a diagnosis but if you don’t use your insurance then you don’t need a diagnosis. (I do not take insurance and so I do not give a diagnosis unless it’s warranted and will serve the client. I’d say most of my caseload is made up of people who don’t necessarily qualify for a mental health diagnosis but do deserve and benefit from professional help. You can speak to the therapist you’re working with to learn more about diagnosis and treatment.)
You don’t have to figure this all out on your own.
(I’ll be writing more about kids and therapy this week. Stay tuned!)