An article focusing on children and families, sandtray, and expressive therapies will be published on this web site quarterly . The intention is to stimulate thought and discussion about creative ways to work with clients.  Your feedback is encouraged and welcome.

This first article addresses decisions that face clinicians who work with children and families.  Who is my client and what is my job? As a play therapist, I am frequently asked to see a child who is experiencing difficulties. But, is the child my client? Maybe. Maybe  not. My client might actually be the family, the parent, the teacher, the referring agency - the Social Service Department, a law enforcement agency, the court, or others.

A four year presented with symptoms of a traumatic stress disorder after a recent disclosure of abuse by a family member. Her sandtray was a powerful projection of her fears, confusion about trust, and attempts to protect herself. Her mother was understandably upset, and wanted her child to heal and the perpetrator to be prosecuted. Unfortunately, with the trauma of her child, this mother came face to face with her own abuse as a child and the effects of her own victimization.  The assessment was that the mother was my client. She needed to be her little girl's parent. Through supportive therapy, psycho-education in reference to the effects of abuse, information re the process of investigation and court proceedings, and filial therapy to give this mother a way to connect with her child, the mother was able to support and protect her child and give her the tools to heal. Four months later, the four year old completed another sandtray that included prospects of danger, but with protection and strength. The mother was my client and both the mother and child benefited.

Parents reported concerns for their seven year old daughter who was described as oppositional and defiant. She was adopted five years before and her difficulties accelerating. Non-directive play therapy with the child, as well as with the child and her family, revealed the child's struggle with belonging, trust, and attempts to control were  her parents. In addition, she seemed confused with her pre-adoption past and the possibility of abuse. More directive play therapy helped the child and her parents address these concerns. Parenting and psycho-education were provided for the parents, as well as plans for behavioral management. The family was my client.

A teacher struggled with the behavior of a six year old boy in her class. She reported that he was very active and disruptive in his first grade class. The boy was in treatment with a psychiatrist to address the attentional difficulties. The teacher was frustrated with the energy it took to manage one child's behavior in a classroom of other children. My client is the teacher, but we would need collaboration between the teacher, parent, psychiatrist, and child to impact the behavior. The teacher needed to know what the parents were doing at home; what worked and didn't work. The teacher and parents needed information about what might help an active six year old attend. The parents and psychiatrist needed increased communication about the concerns. Yes, based on the information from all involved, I did use structured play therapy with the boy to help him calm himself, give him ways to express himself and his difficulties, and techniques to interrupt the impulsive behavior earlier. This was not going to work unless the teacher could guide, remind, and help the child use the skills. The teacher needed support in a difficult job. She could now use this success with other children in her class.

A detective with the city police department interviewed a three year old who witnessed a crime. After several interviews, the child had not yet given information that law enforcement could use. The three year old was referred. My first question is, "Do you want to find out what happened or do you want therapy for the child?". The answer will tell me who is my client. If the answer is that a forensic interview is requested, then the police department is my client. If the answer is psychotherapy, then the child is my client. Play therapy will be the treatment for a three year old, but only an assessment of her strengths and needs and will tell me how I will use play therapy. Of course, I will report information that may reveal itself in therapy, but that is not my main goal.

What is my job? Is my job forensic interviewer or therapist? I can't do both, but confusion about expectations can only be detrimental to process, confusing for the clinician and the client, and unethical as well. Will I use individual or family therapy? Will I use play therapy, and will it be more directive or less structured? Will I utilize filial therapy; the parent is the play therapist? Will I need to consult with others, and who will I need to bring into the process?

In those times when the knot in my stomach tells me there is some confusion in the formulation of the treatment or direction of the case--it seems to help if I ask myself the question….Who is my client and What is my job?