"What Matters?" for PhD clients

For my science friends ...  This is a therapy intervention I came up with called "What Matters?"  You create an atom for each role or roles you have in life and label the parts (and discuss of course.)  Thought you might like it.  :)

Campfire

 Campfires are always a intimate place to share personal stories with friends.  I created this intervention based on the elements of a campfire as a metaphor for depression or anxiety.  I use it in groups, but my colleagues have successfully used it with individual clients.

Before doing this, you'll need to have some shapes already cut from construction paper as well as a large black piece of construction paper for a background (I tape two pieces together.)

The pieces of the campfire are:

• Fuel - various sized rectangles in orange or brown (I prefer orange because the clients will be writing on these and it's easier to read words on orange than on brown.)
• Fire - various flames in red or yellow.  You can even mix these.
• Smoke - puffs or cloud shapes in gray or white.
• Rain - drops of water in blue.
• Water pail - a purple water pail.  This will be added by the therapist at the end.
• TEMPLATES for FIRE, WATER, SMOKE, and PAIL

Most of the processing in this activity happens as the activity progresses.  I usually begin by talking about campfires and inviting the clients to join me around the campfire as we build it together.

1. Have the clients begin with the fuel.  Ask "What fuels (e.g. triggers or brings on) your depression/anxiety?"  Any answer is good as long it's true for that person.  Have them write their ideas on rectangles and then paste them at the bottom of the page.  It's ok if they overlap and you can't read all the words.
2. Once the fuel is done, ask "What does anxiety/depression feel like inside for you?"  These will be the flames.  They will again write on and paste the flames on top of the fuel.
3. The third part is to ask "What do other people notice or what are the signs that you are depressed/anxious?"  You might also say these are smoke signals they send up for help.  These are pasted above the fire with their ideas.
4. Stop and process what it's like to look at the creation and how it feels to know others have similar experiences.  Then move on to coping skills ...
5. The rain or drops of water represent coping skills.  It's a good idea to have different sizes of water drops as some skills work better than others.  Start by asking what usually helps them and have these added to the picture.  They can be pasted directly on the fire if desired.  Usually, depending on when this activity is done during treatment, these ideas might not be very helpful or healthy.  
6. Once the group has finished with their ideas, ask if they feel it's enough to put out the fire.  This is a lead in to introducing other coping methods that will be taught by the therapist.  The therapist can then add the purple fire pail beside the campfire.  The therapist can then add some water drops to the pail with coping methods that will be taught.  Before pasting them down, find out if the clients feel they might be helpful or if they've tried them before and their experience.
7. The therapist should also ask the clients if there are people other than the therapist who can help out.  List these people on the outside of the pail.

Termination Wrap Ups

The school year is coming to an end and so is my time with kids at school.  It's important to wrap up and end the relationship positively.

The Puzzle Method
Take an image that has some meaning to the client or the work you've been doing and cut it into puzzle pieces.  On the back of each piece, write a question or a directive, like a skill you might have practiced together that you can do in session.  (Remember questions about progress and the child's experience as well as favorite things.)  Put the pieces in a bag and mix them up.  (Have a copy of the uncut picture to help in reassembly.)  As the child draws out a piece, read the back and answer the question or do the activity together.

Hidden Termination
This one is for families.  It also involves questions.  Questions should help transition, review progress and new skills, and address any grief at ending.  They should be tailored to the client.  The game involves small candies and a colorful grid. 

To play, the first participant must leave room or close eyes and plug ears while others choose which square is “Pete.”  The treats are placed on the squares. When ready, the first participant is invited to start eating.  When the participant goes to eat “Pete” everyone shouts “Don’t Eat Pete.”  At this point, a termination question is given to the participant.  You can choose to let the participant eat all treats on the board after the question if desired.  Move to the next participant or repeat if needed.

Times Pi Day

I'm a little late, but I wanted to mention two ways to use a paper circle in therapy.

Personal Time Pie:  Have the client divide the pie into percentages of where they spend their time.  Then how they want to spend their time. And then have them keep track during the week to see where they actually spend their time.  Talk about obstacles in getting from here to there.  Talk about why they spend time the way they do.

Family Time Pie:  I have had times when a child wants more attention and the parents feel like they don't have enough time.  I've had the child product two pies: how much time is spent in which areas now and how they'd like it to be.  They can be quite fair.  I have the parents do the same thing.  Then we compare with each other.  Great reality check and perspective enlightening.

Many Selves - An Art Intervention

This is an original intervention I presented at the 2015 International Association for Play Therapy conference in Atlanta, GA.  I was inspired by Internal Family Systems, although, the concept of the self exists in many theories and this exercise can be used well with many theories.

• This intervention explores what roles a client sees themselves as occupying and how these roles conflict or complement one another.
• It also explores how they manifest in or are influenced by the wider world of the client.
• While Internal Family Systems restricts roles to two types, exiles and protectors, this intervention widens the scope to utilize the client's understanding and definition of themselves.

As the client comes to know the real self, they learn how to manage these other internal types and self-competency and mindfulness increase. This exercise, used to uncover the roles a client identifies with, is appropriate for children and adults and is especially helpful with multicultural clients.