Cognitive restructuring occurs regularly in the playroom as a child experiences the therapist’s full acceptance. Teaching cognitive restructuring, however, may expedite the process of having a child experience heartfelt self-acceptance. A useful analogy is that of a school teacher teaching classroom rules. The teacher will allow students to learn classroom rules throughout the first week of school through experience, but prior to that experience, the teacher will verbally share the rules, and may even write them out and post them.
Here are a few ways a play therapist can teach cognitive restructuring:
- Identify and highlight for the child’s their cognitive distortion while tracking play.
“You don’t think you can do it.” (I am helpless or powerless.)
“So, nobody likes you?” (I am worthless.)
“Your teacher should do it your way.” (I should be in charge.)
- Discuss how what we think affects how we feel and how we act.
- Use drawings to illustrate:
- Take 2 sheets of paper and draw an oval face with eyes on each sheet. Write Thought, Feeling, and Action on each sheet beside each face. On the 1st sheet, write “I can’t do anything right” beside the word Thought. Have the child draw a face on the oval showing how the person would then feel. Then ask the child how a sad person would act and write a short answer for the child next to the word
- Next, write the exact opposite of the cognitive distortion (this is a cognitive distortion too!) at the top of this same sheet. For example, “I do everything right!” The child will agree that this is not true. Let the child cross out this statement, or put an X next to it.
- On the 2nd sheet write, “I do some things right!” Help the child think of some things they do correctly. Identify the feelings that go with recognizing what they can do, and encourage the child to illustrate the feelings associated with these abilities on the face. Ask the child how this person might act, and the child’s response next to the word “Action.”
- This activity can be repeated with the child’s cognitive distortion(s), followed by a rational thought developed by the therapist and child.
- Use bibliotherapy. Spry Sparrow: From Drab to Fab illustrates how having a negative cognition contributes to feelings of sadness and anxiety. In the story, Spry compares herself to others and thinks, “I am not good enough.” Spry’s mother helps Spry identify realistic, positive cognitions. Heartfelt change occurs for Spry when she accepts the positive thoughts as real for herself. Encouraging parents to read the book to a child helps the parent understand cognitive restructuring as well.
- As the child plays, track the new thought as the child practices it behaviorally in session. For example, say, “Oh, you did that by yourself! You can do some things!”
- At the end of the session, meet with the child and their caregivers and discuss the new thought. Ask the caregiver to reinforce the new thought: For example, when the child plays with a cousin, the caregiver might reflect that the cousin likes the child and ask the child to repeat, “My cousin likes me! Some people like me!”
- Games such as Land of Psymon, The Positive Thinking Game, and Positive Thoughts are also fun ways to engage in cognitive restructuring.
A cautionary note: Some children are truly unloved and taught that they do nothing right. In these cases, these interventions may not be appropriate in the early stages of therapy, and will need to be preceded by other interventions. It is also important to note that Cognitive Behavioral Therapy has two parts: cognitive restructuring and behavioral change. Children are able to learn new beliefs about the world, their relationships, and themselves by understanding cognitive restructuring. They will also need to practice new behaviors, reinforced with new beliefs, to experience heartfelt change.
Celebrate feeling happier!
Donna is a Licensed Clinical Social Worker and Registered Play Therapist/Supervisor in private practice, in Savannah, GA. Visit her website: http://www.donnahammontree.com/