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Playful Trauma Focused-Cognitive Behavioral Therapy With Traumatized Children

Download the Full Article by Angela M. Cavett here: (PDF format): cavett    OR  (Word format): cavett

Here are some of the interventions she mentions:

book-20clip-20art-di855LndTPsychoeducation is the first component of Trauma Focused Cognitive Behavioral Therapy. Play interventions are helpful to teach the child about trauma. A playful manner to address this is to use bibliotherapy (read the child a book related to the trauma). The child can act out the story with puppets or figurines.

square breathing Four Square Breathing:  Draw a square and label the corners 1. Breathe in, 2. Hold it, 3. Breathe out, and 4. Do nothing. Discuss how a square has 4 sides, each step should take 4 seconds and practiced 4x/day. This will help your child remember this method! Practice the 3rd step using bubbles.  Praise your child for long, relaxed breaths that result in big or numerous bubbles. Another way to practice is by placing a stuffed animal on their belly – they can visually see the stuffed animal moving up & down as they breath.

a1540-capture-trap-spider-man teddy-bear_zps25716857Progressive Muscle Relaxation: Teach your child that muscles can be either Tight or Relaxed. Show them a superhero action figure and a stuffed animal – have your child touch/play with these and feel how hard/soft each one is. Then Dance or March a stiff, hard muscle dance followed by flopping dance – do this alternating between tightening and relaxing.


Meebie: (a plush toy with Velcro facial features) allows for play during the discussion of feelings.


Feelings Tic-Tac-Toe: Engaging came to encourage the discussion of feelings. See my post on this game here for a free print out and more details: Feelings Tic-Tac-Toe


 Mood Manicure: This intervention promotes discussion of feelings. Have your child pick nail polish colors which represent different feelings/moods and discuss them as you polish her nails!

Feelings Charades: This games helps your child understand the expression of feelings. When this game is played with a parents, the child is able to see what a particular feelings looks like in people who are present in their life.


Mad Maracas: Expression of the intensity of emotions through the shaking of maracas.

parachute4Parachute Feelings-Ometer: This intervention helps to understand the physiology of affect. The connections between physiological reactions and the child’s emotions can be revealed through play. Talk to your child about their internal state (heart rate, breathing, nausea etc) – then lead into a conversation about the intensity of emotions. Allows your child to express the intensity of an emotion using a parachute and balls with more intense, vigorous waving for more intensity of affect. Measuring affect allows the child to understand the intensity of the felt emotion and the frequent correlation between intensity of affect and behavior. A Child with a “small” amount of anger is likely to behave differently than a child with a “big” amount of anger.

045878Feeling Abacus: The measurement and expression of the intensity of emotions specifically this intervention addresses the degree of feelings  using beads on an abacus. It helps kids understand the intensity of feelings. The beads on the abacus are used to represent the intensity of the emotion. For example: 1 bead beside the word worried  indicates a ‘small’ amount of anxiety; whereas 5 beads indicates ‘moderate’ amount and 10 indicates ‘the most ever.’

menu138cd6b41bc7ce9debe6c6cfd5aa02c2eAnger Menu: This activity facilitates the identification and expression of appropriate ways to express anger. The child is provided with examples of menus from restaurants to show the multiple options provided on each menu. The child is asked to brainstorm a list of ways to appropriately express anger with assistance. Important to discuss with the child that just like people may choose different meals on a menu, people may also choose different ways to express anger. Once the list of ideas is established create the child’s anger menu with them. Encourage the child to role-play some of the items on the menu and encourage parents to refer to the anger menu while at home to help their child appropriately express anger.

Trauma Narrative: The creation of the Trauma Narrative and the processing thereof. The trauma narrative is developed in therapy over many sessions. The telling of the traumatic experience (creating the narrative) can be done with the child playing out the trauma while dictating to the therapist the trauma narrative. For example, the child may act the trauma out in the doll house with figures. At times, children are able to give additional details when they play out the trauma narrative with the dolls/house that were not in their first verbal telling of the narrative. After the trauma narrative is developed, it is processed at which time psychoeducation addresses responses and normalization of the child’s reactions.

The Who, What, Where and When game: When children present with problems related to discussing the trauma at times that are not helpful for them or their peers, this game can address appropriate situations for the child’s telling of his or her story. The purpose of this game is to increase personal safety skills. Materials Needed: Paper, Tape & Markers. Age: 6yr-11yr. Modality: Individual, family or group. Here is a free printable of generic version of the game: New Who what when where why

Twisted Thinking Game: Reframe distorted cognitions of guilt, blame & responsibility. This intervention allows the child and therapist to process thoughts initially expressed in the trauma narrative that may not be helpful for the child. Materials needed: Twister, Tape, Circle Cutter, Card stock. Age: 8year-18yr. Modality: Individual, family or group.

Here is another Article by the Same Author, “CREATIVE INTERVENTIONS TO ASSESS CHILDREN AND FAMILIES,” download FREE PDF here: assessmentarticle

Here is an Article “Empirically Informed Play Therapy Interventions” by Sueann G. Kenney-Nosizka with more interventions explained: article_noziska


Mother, Pediatric Nurse and a Trail Blazer for Positive Change.

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