Psychiatry - October 2008 - (Page 27)

psychiatrist is interested and listening to the child. The psychiatrist does not attempt to engage the child in some of the games in the playroom. It is important the child lead and the psychiatrist follow. Mike: (Continues to look around the room. He walks over to the Play-Doh bin and gets out several colors. He starts to make several cars out of the Play-Doh.) Look at my cars! Psychiatrist: You have three cars. You made two big cars and a little one. Mike: They’re a family of cars. (He starts to pretend to drive them around the room.) Psychiatrist: The family of cars is driving around together. They are staying very close to each other. (The psychiatrist continues to track what the child is doing, interpreting the play at times.) Mike: (Suddenly the largest car crashes into the wall.) The daddy car was bad and hit a wall. No more daddy car! He shouldn’t have done that. Now he’s all gone! Psychiatrist: That car did something bad and now he’s no longer a car. (The child seems to be escalating in anger at this point. He starts to crush all the cars and turn them into balls of Play-Doh.) The family of cars is all gone now. Mike: Yeah, now they are all bombs. I’m going to blow up this place. Psychiatrist: The family of cars has turned into weapons. You want to blow up this building with them. (The therapist tracks his behavior and allows him to show his anger.) Mike: I’m going to blow you up. (He starts to throw the Play-doh balls at the therapist.) Psychiatrist: I know you would like to blow me up by throwing those bombs at me. (This comment demonstrates the psychiatrist’s empathy with the child.) But you may not throw things at me. You may throw those bombs at that stuffed bear. (The psychiatrist points to a large bear sitting in the corner of the room.) Practice Point. It is important to set limits in the play room when appropriate. The child should not be able to hurt himself, the psychiatrist, another person, or destroy property. A good way to set limits is this way: First, acknowledge what the child wants to do, e.g., “I know you would like to blow me up by throwing those bombs at me.” This helps to empathize with the patient and makes it more likely the limit will be followed. Second, communicate the limit to the child, e.g., “You may not throw things at me.” Third, give the child an alternative, e.g., “You may throw those bombs at that stuffed bear.”20 Mike: (Turns to the bear and throws the Play-Doh at it.) The bear is all blown up! (He says this with a big smile.) Psychiatrist: You are happy because the bear is blown up. (The psychiatrist appreciates his smile as being happy and reflects this feeling in her interpretation.) the bookshelf where the blocks are stored. He gets the blocks down.) You build a small house and I’m going to build a big house. (The psychiatrist does not interact in the play until invited to by the patient. The child has invited the therapist to play blocks with him. The psychiatrist complies with the child’s request and starts to build a house.) Hey, your house is bigger than mine. Now, I’m going to have to make my house even bigger! Psychiatrist: It’s important to you that your house is bigger than mine. Mike: Bigger is better. Psychiatrist: Whoever has the bigger house is better. Mike: Can you get those people down from the shelf? They are going to live in the house. Psychiatrist: You can get the people down off the shelf. (The therapist acknowledges Mike’s ability to do things for himself. He can satisfy It is important to set limits in the play room when appropriate. The child should not be able to hurt himself, the psychiatrist, another person, or destroy property. A good way to set limits is this way: First, acknowledge what the child wants to do This helps to empathize with the patient and makes it more likely the limit will be followed. Second, communicate the limit to the child Third, give the child an alternative 20 Mike: The bear is alive. (He goes over and picks up and cradles the bear.) He is hurt. I don’t know if he’s going to die. (Mike goes and finds the nursery bottle and starts to pretend to feed the bear.) Psychiatrist: You are afraid he is going to die. You are going to help the bear. Mike: He is all better now. Psychiatrist: You have nursed the bear back to health. He is going to be just fine. (The therapist acknowledges his anger and his fear that his anger can hurt things. The psychiatrist also acknowledges his need to know that his anger will not destroy things.) Mike: I’m going to build a house with these blocks. (Mike walks over to some of his wants and needs.) Mike: I think it’s too high. Psychiatrist: I think you can reach that. (The psychiatrist continues to acknowledge his abilities and encourages him.) Mike: (Walks over to the bookcase, reaches up and grabs the play people.) I did it! Psychiatrist: You did it by yourself. (The psychiatrist’s comments reflect his abilities to do things for himself and affirm his self-sufficiency.) Five minutes until our time is over. (Mike continues to build on to his house with the blocks.) Practice point. Giving children a five-minute warning allows them to know that you will be leaving the room [OCTOBER] Psychiatry 2008 27

Table of Contents Feed for the Digital Edition of Psychiatry - October 2008

Psychiatry - October 2008 Editor’s Message Editorial Advisory Board Contents Psych Rx Treatment of Migraine and the Role of Psychiatric Medications Play Therapy: A Case-based Example of a Nondirective Approach Delirium and Antipsychotics: A Systematic Review of Epidemiologyand Somatic Treatment Options Severely Mood-disordered Youth Respond Less Well to Treatment in a Community Clinic than Youth with Bipolar Disorder Beyond Informed Consent: The Ethics of Informing, Anticipating, and Warning Asthma: Wheezing, Woes, and Worries Classified Advertising Journal Watch Information for Authors

Psychiatry - October 2008

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