Fall 2024 Issue

Therapy: Somatic Play Therapy
By Heather Rose Artushin, LISW-CP
Social Work Today
Vol. 24 No. 4 P. 28

Addressing Childhood Trauma in the Body

Play is the primary modality children use to express themselves, make sense of the world around them, and connect with others. Play therapy has been shown to be an effective approach for preschool and school-aged children to address a variety of concerns, including emotion regulation, social skills, behavioral issues, and developmental disorders.1

For children who’ve experienced trauma early in life, preverbal memories can wind up stored in the body, causing somatic symptoms and distress. Incorporating a somatic approach to play therapy in these cases can be transformative in working through the emotions held deep in the body, beyond words.

Emily Benson, a licensed clinical social worker and registered play therapist supervisor, owns Beginnings & Beyond Counseling/Play Therapy in Minnesota, where she addresses complex developmental trauma using play therapy, Somatic Experiencing (SE), and coregulating touch. Trained in Experiential Play Therapy, she emphasizes the importance of observing the soma of children, along with their play and verbalizations. “I believe to ignore what the body is telling us would be missing a very big part of a child’s story that they cannot articulate because it is coming from an unconscious part of the brain and lives within the body,” she explains.

SE is an approach that treats somatic symptoms by changing the interoceptive and proprioceptive sensations associated with the traumatic experience.2 One study showed that SE led to significant symptom reduction in both PTSD and depression.3 “I would describe a somatic lens as being attuned to small nuances and sometimes bigger ones that include body movements, postures, and other indicators that are nonverbal in a child’s body that lend critical information to the child’s story and trauma history,” Benson says. “In simpler terms, learning to read the story of what the body is telling us about someone’s experiences in life all the way back to the womb.”

While somatic play therapy can be a useful framework for any child therapist to adopt, it’s particularly relevant in helping children through trauma. Preverbal trauma can emerge through somatic play therapy, bringing clarity to what a child experienced very early in life. “It can be particularly useful when used skillfully and with enough information, meaning consistent behaviors over the course of treatment, in lending clinical hypotheses of what a child may have experienced that they are unable to verbalize,” Benson says, “possibly due to the age of the child and the experience being preverbal.”

Somatic play therapy also empowers clinicians and children with a pathway for healing trauma without retraumatization. “I’ve worked with many children with histories of sexual abuse,” Benson says. “Having somatic awareness of what may have happened to a child without having to ask them to verbalize it and still be able to support them in their healing is invaluable. Talking about trauma can be retraumatizing. Somatic work doesn’t require words. It’s right brain- and body-based healing.”

Maggie Kline, a psychotherapist who specializes in somatic and attachment play therapy for children and teens, has cowritten two books with SE founder Peter Levine, PhD: Trauma Through a Child’s Eyes: Awakening the Ordinary Miracle of Healing: Infancy Through Adolescence and Brain-Changing Strategies to Trauma-Proof Our Schools: A Heart-Centered Movement for Wiring Well-Being. For Kline, who continues to teach her unique approach to play-based somatic therapy to practitioners around the world, attachment and coregulation are pieces of SE that are often at the forefront of her work with children and teens who experienced early childhood abuse or neglect. “The first year is critical in developing the physiological underlying nervous system to be able to have resilience,” she says. “Kids must experience coregulation with a regulated adult before they are able to emotionally self-regulate. It’s not something you can teach them; it’s the nervous system to nervous system transmission. I’ll sit with my clients on the floor, like being in the living room at home, so I can seat myself about a meter or less away from the child so they can sense safety and containment through my regulated nervous system the same way an infant can feel its mother when they are close together.”

According to Kline, much of somatic play therapy is rooted in an understanding of the nervous system’s three activated responses—fight, flight, and freeze. When practitioners observe their young client’s nonverbal cues closely, they can better understand how the child’s nervous system is being activated and gain insight into ways to address the trauma held in the body somatically. “Somatic play is more about having the child play and feeling inside her own body in resonance to sense where they are and what they need. Do they need social engagement to bring them out of a nervous system freeze? To run and play a chasing game? Quiet play or drawing to help them notice what’s going on inside?” Kline often uses a gingerbread cookie outline so children can map different physical sensations, as well as emotions, by coloring the size and shape of where they “live” inside the body and how they feel. Expressing themselves somatically, each child manifests a very unique body story.

A 17-year-old client who suffered severe trauma and neglect before the age of 5 and was adopted by a loving family came to Kline for therapy after receiving multiple avenues of treatment for depression. “He came in and slouched in the chair as low as he could go, and I was sitting close, across from him,” Kline remembers. “I mirrored him a little bit; I relaxed in my chair, but I didn’t cross my arms like he did, I kept myself open. I looked at him and waited. Finally, he said, ‘I don’t want to be here. I’ve been through this before; I’ve been to therapy.’ I just waited, and he said, ‘I know what you want.’ I said, ‘Oh, tell me.’ He said, ‘You want me to talk about my feelings, and I’m telling you right now, I won’t.’ Well, why would a kid want to talk about his feelings? Especially from his past when half of it is in implicit body memory.”

Kline recalls how the teen client would oscillate between major depression and aggression in his daily life and how she perceived his body language in their first session as a protective stance. “I just looked at him and said, ‘I’m so relieved. I’ve been listening to people’s feelings all day, and I’m so tired of it! What do you do for fun?’ So I brought in play, but I’m not going to introduce him to GI Joe or puppets at 17.” Her playful response and a hint of humor seemed to open the door for conversation with her resistant client.

He told Kline he was interested in skateboarding and surfing, so she decided to offer a fun surprise. “I said, ‘I think I have just the right thing for you.’ When you have a child who’s depressed, surprise stimulates the reticular activating system in the body, so instead of being shut down all of a sudden, they sit up and take notice; it’s just a little bit of stress in a positive way to bring out alertness. So I said, ‘Close your eyes!’ I went behind the couch and brought out a wooden balance board that was very expensive and nuanced and had 12 different settings that got increasingly difficult. ‘This can help with your surfing.’”

As Kline and her client played on the balance board, she offered attunement, safety, and playfulness that were unlike anything he had experienced in therapy before. “I stood next to him like you do in gym class as a spotter and said, ‘I’m going to spot you—I know you don’t need that, but I’m going to stand here anyway because my job is to keep you safe.’ He had never had safety in those first years of life, so that sent an important message to his nervous system. I stood with my hands close to his shoulders and imagined supporting him as a mother would her baby.” Along the way, Kline was careful to incorporate humor and eye contact, specifically what she describes as “kind eyes and soft face,” a gentle tone of voice, and rhythmic breathing.

By the end of the session, her client challenged her to attempt the most difficult settings on the balance board. “He laughed and said, ‘I bet you can’t do it!’ I said, ‘Well, I don’t know, let’s see. Would you spot me?’ I was doing serve-and-return [mimicking the back-and-forth interactions between a child and responsive caregiver in early life]. He was right; the very last one I couldn’t do,” Kline laughs. “He thought it was hilarious, and that’s when he said, ‘When can I come back?’ He left that office with a big smile on his face. So I continued to work with him.”

This powerful approach isn’t only for working with children. Kline also recalls a 60-year-old client she worked with who was neglected as a baby. When Kline spontaneously got the idea to play patty-cake together, her client laughed, shed tears of grief, then tears of joy. “If an adult was neglected and they are having relational symptoms, high ACEs score, even health problems like cardiac issues, sleep or digestion concerns, this kind of somatic play addresses their past to find healing.”

While Benson believes anyone can be taught through a somatic lens, the approach isn’t necessarily a good fit for every clinician. “It’s a right brain intervention, so a clinician who is very analytical or who believes talking is the best intervention might not find that it’s a good fit for their practice,” she explained. “I also think it’s important to be sufficiently trained, certified if possible. For me, four years in training as a Somatic Experiencing Practitioner and Co-Regulating Touch Therapist have allowed me to be more in touch with my own sensations and body, which is essential in using it as an intervention with clients.”

For clinical social workers who specialize in supporting people through early childhood trauma, somatic play therapy can address the memories and emotions held deep in the body, in the preverbal unconscious mind, where perhaps deeper healing can be found. “I believe it’s the gentlest and most effective treatment for trauma of any modality I have encountered,” Benson concludes. “If we allow a body to tell us the story, it will tell it. Much of what happened to us began before or during birth—pre- and perinatal science supports this theory—and set the stage for our nervous system for everything after it. Somatic work allows us to go back to the beginning, if you will, which allows for healing of coregulation, attachment, and nervous system stabilization.”

— Heather Rose Artushin, LISW-CP, is a writer and bibliotherapist committed to making a difference, one word at a time. Connect at https://heatherrosewriter.com.

References
1. Koukourikos K, Tsaloglidou A, Tzeha L, et al. An overview of play therapy. Mater Sociomed. 2021;33(4):293-297.

2. Kuhfuß M, Maldei T, Hetmanek A, Baumann N. Somatic experiencing — effectiveness and key factors of a body-oriented trauma therapy: a scoping literature review. Eur J Psychotraumatol. 2021;12(1):1929023.

3. Brom D, Stokar Y, Lawi C, et al. Somatic Experiencing for posttraumatic stress disorder: a randomized controlled outcome study. J Trauma Stress. 2017;30(3):304-312.