Interview: Art Therapists on Therapeutic Toys

Monday, I spoke to two practicing art therapists (separately) about how a toy might soothe a traumatized child while improving the child-caretaker relationship. Below are the combined and selected interview notes.

What do traumatized children choose as transitional objects and why?

AB: The first transitional objects that a child has are the nipple, the bottle and the thumb. Traumatized children regress to thumb sucking as a surface behavior that indicates that they are looking inward to soothe themselves. It might help to understand how the brain develops. The bridge between the left and right brain forms around age five. Between five and eight, children are the most vulnerable. Most phobias are developed in this age range. Any positive or negative experience with objects will help form a child’s personality.

CM: That’s often a matter of personal preference. What does it smell like? Who does it remind the child of? Then there’s the question of age and developmental level.

How do children interact with these objects?

AB: Children think of a teddy bear as a part of their arm. It’s an extension of their ego. The teddy bear is them. You’ll see them talking out internal conversations through puppets.

CM: Traumatized children will act out (sometimes repetitively) the traumatic event through toys. There’s something called, “Sand Tray Therapy” where the child is given a large tray of sand and a shelf of objects to play out scenarios. These objects include human representations of various sizes, models of everyday things, animals, and so forth. The sand tray is a stage that lets the child act out his internal struggles. It’s part of the healing process.

If a toy were to improve the relationship between a child and its caregiver, what would be some signs that a caregiver should intervene in a child’s play? What should the caregiver do?

AB: In crisis management, we are taught to deal differently with each stage of the anger cycle. First comes anxiety, where we try to create a safe environment. Second is the defensive stage where the person attacks verbally. We need to set clear and simple limits that we are ready to enforce. In the third stage, the acting out is physical when we need to talk them down, restrain them, and give them quiet time. Finally, there is a time for tension reduction. This is the best time to start a therapeutic rapport by being supportive and non-judgmental.

CM: You have to trust that your child knows how to work through his problems. Some parents are too eager to make the child talk about something that he isn’t ready to discuss. As children play out the trauma, they will often work in metaphor. It’s important not to assume what a certain representation is. Rather, ask the child to tell the story of what he’s drawn or the scenario that the toys are showing. Children will talk when they are ready.

What are some things I should consider in designing a therapeutic toy?

AB: There are a few avenues that come to mind. One, you could look into objects that make regression safe from ridicule. Dual-purpose objects such as a water bottle that can simulate nipple/thumb sucking can be comforting and the parent would have to refill it. You could make a plush backpack that would function as comfort and storage. Two, you can examine the signal value in a toy. Plush toys can transform by having certain parts of itself pulled over or inverted. When a child does that, it can intuitively signal distress to the caregiver.

CM: Simple is better. Give the child the opportunity to fill in the details with his imagination. There’s a big opportunity to train parents through toys. After a disaster, the parents are often themselves stressed but don’t have the socially acceptable option to play with toys. So playing with their children can be helpful by itself. I like the idea of some sort of signaling device that reminds and alerts parents to moments when their child wants to talk or to show them something. It’s not always a display of anger that requires attention. But you also can’t force the stories. A toy that asks the child to face an issue before he is ready isn’t helpful. Giving the child a choice of what to express is. If you’re going site specific, give the child options to directly relate to the trauma. In New Orleans, boats and water are symbols of what happened.

Lessons: Children relate to toys on a personal level. They use them to frame and re-contextualize traumatic events. Creating positive meaning requires a safe space and tools for the child to explore what has happened. Perhaps the plush toy isn’t the right way to go. (I also don’t know if they are as common in Chile as in the US.) Perhaps it makes more sense to create a series of plastic toys that enable a level of reenactment of events: pieces of traditional houses, people of various sizes, animals and large objects that are central to the disaster and the culture. In turn, these objects become a way of communicating with caregiver about what happened and the need to look forward. If I design something that is more directly comforting (that the child can hug), it should enable the tactile and emotional support of regression; it has to feel right.

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