Digital Play Therapy

A Clinician's Guide to Comfort and Competence

Jessica Stone

• Publisher: Routledge
• Year: 2021
• ISBN:
  9781000531282
• Edition: 2
• Topic: Psychology
• Subtopic: Clinical Psychology
• Index: Psychology

The newly updated Digital Play Therapy focuses on the responsible integration of technology into play therapy during and after the COVID-19 pandemic.

With respect for the many different modalities and approaches under the play therapy umbrella, this book incorporates therapist fundamentals, play therapy tenets, and practical information for the responsible integration of digital tools into play therapy treatment. All chapters have been updated, and new chapters discuss strategies for using teletherapy effectively during and beyond the pandemic.

This revised edition provides a solid grounding both for clinicians who are brand new to the incorporation of digital tools as well as for those who have already begun to witness digital play therapy's power.

1 Introduction

To Begin

DOI: 10.4324/9781003166504-1

Play therapists understand play. Of any group of psychologically focused professionals, play therapists know more about the intricacies, nuances, fundamentals, and processes of play than anyone else. The therapeutic powers of play, fueled and guided by a trained professional, can drastically alter a child’s understanding of themselves, their place in this world, and aspects of interpersonal interactions.

A significant portion of the play therapy process is understanding what the client’s language is. What is it about their vernacular, cadence, vocabulary, and content that really illustrates who they are? Who they want to be? Who they have been? How does the play therapist incorporate what is understood about the client into the treatment progression? Speaking the client’s language through play therapy allows a window through which these important questions can be answered. The use of digital tools in play therapy is a way for therapists to honor and incorporate the client’s current language. This book intends to provide a solid foundation for the appropriate, therapeutic use of digital tools in play therapy.

This author echoes sentiments written by Paul Abney and Cleborne Maddux in 2004: “We should avoid pointless and destructive polarization of the counseling field such as that which took place years ago in psychology as a consequence of disagreement between behaviorists and cognitivists” (p. 19) and “tolerance of dual approaches to applying technology in counseling will best permit the counseling field to progress” (p. 2). Concerns about a divide in play therapy was also raised by Snow et al. (2012). The approach followed for this book is focused on the responsible integration of technology into play therapy, both in-person and via telemental health. There is no intent for division or controversy, rather, an acknowledgement that there is room for many different modalities and approaches under the play therapy umbrella. There is room for us all.

Author’s Journey

As an undergraduate student searching for a doctorate program, I knew I wanted to work with children and earn a PhD in psychology. I was not exactly sure what type of programs to look for, and the task was daunting. The California School of Professional Psychology (CSPP) had a program in Fresno, California, which looked promising. This program had an emphasis in Ecosystemic Clinical Child Psychology, led by Dr. Kevin O’Connor. Honestly, I had never heard of the program, Dr. O’Connor, or play therapy, but it seemed to fit the criteria I had at the time. I applied, was accepted, and moved to Fresno, California, to begin my first Fall semester as a G1 (Graduate Level 1) student.

The Association for Play Therapy was relatively new at that time, and the office was housed in my graduate school. I worked there as a helper, an “envelope stuffer” if you will, and volunteered at a few conferences. The board meetings were held locally, and I was able to be exposed to many of our play therapy pioneers. Throughout my time at CSPP, I was fortunate enough to be exposed to and trained by some of the most prominent play therapists and psychologists of the time. I am very thankful for my education and believe the program was ultimately the right fit for me.

I have had a few areas of interest and focus over my now three-decade-long career. An overarching focus has been the importance of incorporating and, in a way, capitalizing on the interests of a client. “Capitalizing” is the chosen word because the information gained by understanding these interests is invaluable in the therapeutic process, and utilizing them to better the treatment process is important. Speaking the client’s language is a powerful and necessary tool when working with clients of all ages, and particularly children. It is a way to honor and understand the client. What is it that interests them? What topics or activities bring cohesion to their experiences and beliefs? How can I, as a therapist, understand my clients better, see into their world view, and help them improve their lives through speaking their language?

Over the decades, different trends have been brought into play therapy sessions by clients. I have always seen it as my job to explore these trends and interests and see what therapeutic value might lurk within. For example, when Pokémon cards were first extremely popular, many play therapists were expressing their dislike. I would teach a class and bring up Pokémon, and there would be a collective groan in the room as play therapists were tired of hearing about this fad. Because of my speaking-the-client’s-language-viewpoint, I did not feel that way. I saw these cards and their characters as a gold mine of information about the client. What character(s) was the client attracted to? What were the strengths and weaknesses of these characters? What did each evolve into? It seemed very natural to me to wonder about these aspects. I also noticed that the clients enjoyed my genuine interest. I recognized that the clients felt seen, heard, understood, and important. This is a fundamental human desire.

An expertise in using board games in therapy was developed through work with Dr. Charles Schaefer. This relationship and common interest led to a coedited work, Game Play, 3rd Edition, 2019, and a chapter in the Handbook of Play Therapy, 2016, on Board Game Play Therapy. The work which has included the underpinnings of using board games in play therapy has been an important foundation for the work with digital tools in play therapy.

An expertise in working with gifted people arose from the desire to be educated in the area due to the needs of numerous family members. This culminated in a variety of writings, including a chapter focusing on the gifted people in my edited book, Integrating Technology into Modern Therapies (Stone, 2019). Although the overall gifted population is small, a portion of my private practice clients have been of higher-than-typical intelligence. The education and readings in this area have certainly been beneficial, but the focus on speaking the client’s language has been key in working with gifted people as well. Again, it is the focus on what is important to the client that fuels a strong rapport irrespective of the population, diagnosis, level, and interest.

Interest in Digital Tools

There is an irony in my current area of focus that is not lost on me. I am not an inherently tech-savvy or even tech-interested person. I fought against the trend of getting a cellular/mobile phone in the early 2000s. I vividly remember saying “I don’t need to be that connected and available all the time”. I did not allow my older children, now in their 20s, to get a PlayStation console when they were little. At the time, it was so new, and I did not really understand very much about it all. I have not been a person who wants to have the newest technology or learn to code or need a lot of gadgets. Until…

There are many spokes to this wheel for sure. If we place digital items in the center and have the spokes coming out in all directions, there would be personal, parental, and professional arenas. I was wrong in the early 1990s – I do want to be connected with others, and I want to have the option to be very connected or minimally connected. There was a day when I was scheduled to provide psychological testing of a child for a local psychologist. I was on my way, and my car broke down on the busy California freeway. Thankfully I was safe and not harmed, but I was frantic because I had no way to tell this family what had happened. It was a Saturday, and the office building was locked without me there. I could only imagine what they were experiencing: prepping their child to attend the appointment, dedicating their Saturday, driving to the building, only to find that it was empty. The door was locked, lights off, and they had no way to get in contact with the person they were to meet. I really, really wished I had had a cell phone. I got one as soon as I could after that.

There are many areas of our lives that benefit greatly from the current digital technologies. In speaking with a colleague recently, it was said that the current shifts are the biggest technological advancements since the Industrial Revolution. The direct and indirect effects of the current advancements are creating ripple effects in many directions. I believe we are only seeing the very beginnings of what is to come. With great change comes a host of pros and cons. It is inevitable. As Jeffrey J. Magnavita stated in his 2018 book, Using Technology in Mental Health Practice

What is familiar to us is comfortable and feels secure, but the disruptive nature of change is unavoidable. Rather than fearing that our work will be subsumed by technology, we need to be adaptive and open to new ways of providing care. Our work is still relevant.

(p. xiv)

There are certainly concerns along the way, and these are not to be ignored, however, the reality is that digital tools are here to stay, and utilizing them to benefit our clients therapeutically is of utmost importance.

Runescape and the Importance of Joining Their World

During the years leading up to 2011, I began to adopt more types of digital technology into my day-to-day life. My children became interested in different types of video games and consoles, and, yes, we ended up with a PlayStation. I saw their interest and decided I needed to learn more. I often give this example of wanting to join them in what they were playing. I wanted to understand what they were doing and, as much as I could, why they were doing it. I asked about an online game my older children really enjoyed called Runescape. Runescape is an action-adventure game (more about that in subsequent chapters) in which your character explores the land and various maps to accomplish a whole host of tasks and quests. I decided I would make an account in this game and enter my children’s world. The funny thing is, I am really not very good at these games. I am a bit directionally challenged and I would get lost in the maps all the time. I would wander into places and get my character into trouble. I felt like I was really going to fail at this attempt. One day when I was logged in and feeling determined, I came upon a village. I saw people gathering feathers, bones, and meat from the chickens in an area of the village. It was a safe section of the Runescape world, and other characters were wandering around collecting, cooking, and selling a variety of items. This was much more my speed!

I camped out in the chicken coop area and began collecting feathers, bones, and meat. I soon realized that these items were needed for particular quests, and players needed them in great quantities. I decided to set up a business. I would log in and camp out in this area. I was known as the “chicken lady” in the game, and eventually people would ask when I would be playing. The community of online players knew me as a person from whom to get these items, and they would seek me out specifically to buy them. They did not want to waste their playing time gathering the large quantities needed for certain quests, and I had the supplies readily available to sell. It really was a win-win situation. My children thought I was a pretty cool mom, and I was seriously rich in the game currency. I believe it brought my children and me even closer together. I took interest in something they were playing. They could see when I was online because we were friends within the game. They could come and chat with me and see what I was doing and then go off and do what they wanted in the game, which was always much, much more advanced than what I was doing. I am so glad that I decided to make that account, even if I never ventured terribly far past my role as the chicken lady.

Personally, I felt pretty darned accomplished in the little Runescape role I carved out for myself. The initial fear and feeling of failure while playing was not something I wanted to continue feeling. I could have decided the game was not for me and deleted my account. The problems with that approach were that 1) I do not like giving up and 2) I really wanted to understand more about what my children were doing. I knew I had to work through my frustration to find a way to make this workable. Once I had my role as the chicken lady figured out, I really felt a sense of belonging and community. I do understand how odd that sounds to those who do not play these types of games; however, it is true. It was an unexpected artifact of the game play. I contributed something to this society, and I earned a place of importance, albeit minimal. I made friends with people within the game. They only knew my username and my role and reputation as the chicken lady to identify me, but we would chat online within the game and check in with each other. There were certainly people with whom I felt a camaraderie. No wonder my children enjoyed this game. They could explore, achieve, attempt, fail, connect, and so much more. They could try and try again, without tremendous risk, until they were successful.

I remember one day when my oldest son came to me devastated because he had been attacked, and many of his valuables had been taken. There may have even been some trickery involved. I know he remembers this vividly as well. He was in such pain. The thing is, without having played the game myself, I would have seen my son in pain and tried to comfort him without really understanding what had really happened. However, because I had entered his world and I understood what he meant when he explained what had happened, there was a whole new level of connection and comfort I was able to provide.

I learned so much about connection through my experience as the chicken lady, and I am forever grateful.

I decided that I had a whole new area of life to understand and learn about. I needed to learn more not only to understand and connect with my children, but also to understand and connect with my clients. This is their language, and it is our job as play therapists to speak it. I started to research and ask my children about all sorts of games and programs available. I fumbled a bit and more than a few clients and I giggled about my feeble attempts, but I believe they appreciated my interest and efforts. All of this was the foundation for my next professional focus, unbeknownst to me.

In 2011, a tsunami hit Japan, and a dear friend, Dr. Akiko Ohnogi, published a plea online for play items to be sent to Japan. She and her colleagues were working with families in the midst of the destruction without many play materials. Our local news station interviewed me about the need for materials, and people donated some amazing things. I went to Target (chain store) and bought as many things as I could afford. Federal Express donated the shipping of four large boxes to Japan. It was what we could do from afar.

The Birth of the Virtual Sandtray

I began to wonder, though, given the popularity of sand therapies in Japan, how on earth would that be possible? Even portable trays and sand are bulky, heavy, and cumbersome. How would that work in the crisis situation they were faced with? I said to my husband, Chris, that we need a more portable sandtray. It needs to be truly portable. It needs to be on an iPad. I had just gotten my first iPad as a Mother’s Day gift. Truth be told, it had really been taken over by the kids and seemed more like a gift for them. By this point, I had four children, and all of them exceeded my technological abilities, even the small ones. However, knowing what the iPad was capable of and how portable it was let me know that it was the perfect medium.

Chris has long been my go-to tech person. He has had a long-standing interest in computers and coding. When I spoke with him about my idea, he was unable to help because of other commitments. My older sons and I purchased books to attempt the project, and I did the “poor man’s patent” of mailing myself the idea through the U.S. Postal Service. I was not sure what good that would do, but I thought it was a place to start. I called around, and the least expensive bid I received to start the project – not for a completed project – was $35,000. I knew that figure would double or triple if I moved ahead, and I quickly put the phone down in disbelief and sadness. It looked like the iPad sandtray idea would not come to be a reality.

Sometime later, Chris began the project. His work has been above and beyond what I had ever imagined. The Virtual Sandtray was born. This has been a family passion project for over 10 years. We continue to expand upon the original ideas and had programs for iPad and the Vive, Oculus Quest 2, Rift S, and Hewlett-Packard virtual reality systems. I am so very proud of our family and thankful for Chris’ dedication to something he originally did not even fully understand (sand therapies). So, I disclose to you that I have a financial tie to the Virtual Sandtray, if you want to call it that; we have financed the project all on our own and our debt far, far exceeds any proceeds. The patent application alone has cost more than $25,000 to date, and we are proud to say it was granted in the fall of 2020. This is a project born out of a need and fueled by beliefs that 1) accessibility matters and we are contributing our small part, 2) speaking the client’s language is of utmost importance, and adapting tried and true methods to current language(s) is imperative, and 3) sand therapies are amazingly powerful.

This book has been quite a journey for me. Initially, I proposed it as a basic introduction and guide to the concepts and therapeutic uses of DPT. It seemed quite reasonable to start at the beginning and work through important concepts so that one can 1) determine what the therapeutic value of these tools are or can be; 2) understand the basic therapeutic underpinnings; 3) receive some information and direction regarding set-up within the play therapy office; and 4) explore ways to write notes, speak with parents, and speak with collateral contacts about the work. As the writing continued, and frankly at the publisher’s due date witching hour, I decided the book needed more. There is no way this volume will cover every aspect (and...