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.

What makes an object participatory?

If my goal is to improve the relationship between a traumatized child and stressed caretaker, I need to consider how social objects work. In the Japanese tea ritual, the host often places a single object of floral arrangement on the table for contemplation. That becomes a focus of meditation or a start of conversation. I’m looking for a kind of translation of that between a distressed parent and traumatized child, something that by itself is inviting so you don’t have to have the ritual for the idea to work. The ritual makes itself.

According to Nina Simon, a social object is one that connects the people who create, own, use, critique, or consume it. Social objects are transactional, facilitating exchanges among those who encounter them. For example, one of my most reliable social objects is my dog. When I walk around town with my dog, lots of people talk to me, or, more precisely, talk through the dog to me. The dog allows for transference of attention from person-to-person to person-to-object-to-person. It’s much less threatening to engage someone by approaching and interacting with her dog, which will inevitably lead to interaction with its owner. Unsurprisingly, enterprising dog owners looking for dates often use their dogs as social instigators, steering their pups towards attractive people they’d like to meet.

Whether in the real world or the virtual, social objects have a few common qualities. Most social objects are:

1. Personal
2. Active
3. Provocative
4. Relational

Activating social objects in museums is a function of asking the right, open-ended questions and inviting participation. Displayed comment cards asking visitors to make sense of an exhibit invite other comments. Actors interacting with an exhibit encourage others to photograph themselves engaging in the exhibit. The key is providing the right context and prompt to push people in the right direction.

A toy must first relate to a child’s personal experience. Its form must be close enough to some familiar and favorable construct (such as a favored animal) that the child bridges that gap with imagination. Making the toy personalizable through clothing, snap on elements, or physical manipulation (such as flipping a stuffed animal inside out) can facilitate new narratives. A toy that is active must change as the child rewrites his narrative. A toy that is provocative captures initial interest and maintains it by adapting to the child’s moods. Finally, a toy that is relational encourages that child-to-guardian interaction by telling the parent when and in what capacity to engage in dialogue or play with the child.

Simon, Nina. The Participatory Museum. Santa Cruz, CA: Museum 2.0, 2010. Print.

GFRY: Early Stage Opportunity Identification

This week, we continued brainstorming opportunities that we thought our partners would be interested in. We then looked at what we thought the people of Talca would need. We then filtered these opportunities based on our own design interests to present three ideas.

Interview on Stuffed Animals: Divorced Mother of Three

I asked a friend how her three children interacted with stuffed animals. Below are interview excerpts:

Me: What kinds of stuffed animals do your kids like?
They like all sorts.
I am trying to find out which forms and materials are the most engaging/comfoting/enduring.
They seem to like floppy ones best.
How large are they?
About 8 inches long seems to be a favorite size made out of something pretty soft, something that doesn’t pill or get nappy. I like machine washable stuff, of course.
What shapes are they?
The kids all three have dogs that they have been attached to for an extended period of time.
Are any of them kind of amorphous or are they all clearly specific dog breeds?
Just kind of dogs, not specific breeds of dogs and they lay flat, with their legs spread eagle, you know? They like the ones with long ears best. Henry also really likes panda stuffed animals. Lily likes her floppy elephant best right now, she says.
What makes them comforting?
I think that they are soft and squishy and easy to cuddle.
After your separation, did you notice any different behavior with the stuffed animals?
No, no real difference.
On a scale from 1-10, 1 being not traumatized at all and 10 being total emotional wreck, how traumatized do you think they were?
Hmm… 6 for a while… no… 4. They’re used to it, he left all the time, anyway
When that first started happening, was it higher?
Yeah, definitely
Did you notice anything different in their interaction with stuffed animals then?
There was maybe more of a ritual about them. They took more “care” of them. Tthey would give them baths, tuck them in to bed, that sort of thing.
Were they ever aggressive towards them?
Henry has thrown them a couple times, yes. Not so much the girls.
What was the timing of that aggression?
It’s been off and on during the past year.
Did it coincide with troubling events in his life? Maybe bullying?
He was actually more aggressive when the ex was around. I think he was trying to assert some sort of dominance.
How did you react to the aggression?
Remove him for a quiet place where he can calm down and explain that agression isn’t acceptable.
How does he react to punishment?
Sometimes he cries, sometimes he just pouts. There are minor tantrums when he’s super tired.
Does punishment change his behavior towards the stuffed animals?
No, we practice being sweet with the animals. He gives them hugs and kisses. He throws them when he is frustrated.
To what extent do you feel the stuffed animals are anthropomorphized? 1 = totally inanimate, 10 = totally alive

Key insights: This confirmed some of the findings on form in the post-it exercise on Monday. I am still unsure whether aggression towards stuffed animals is a healthy outlet, especially if they are anthropomorphized to the extent of being half-alive. Caretaking is a stress-triggered reaction that may have development potential.

The Power of Storytelling

In an HBR article on using stories to overcome fear, Peter Guber describes how leaders can effectively use stories to build consensus. He relates his experience trying to convince Loews to build its first multiplex in Manhattan.

In telling my story, I first engaged them with a question. I asked: What if a group of hungry people went into a large food emporium? If one particular food was missing or sold out, there was so much else there they could choose from. “We should make movies that people consume emotionally with the same availability as a food court,” I told them. “If the movie that brought you to the theater is sold out, there were 15 or 16 other movies to consume and enjoy.” My management team bought into it and executed on the story. The result was the Sony 67th multiplex, which was an enormous success.

A story is a vehicle that puts facts into an emotional context. The information in a story doesn’t just sit there as it would in a list or data dump. Instead, it’s built to create suspense and engage your listener in its call to action. Facts and figures are memorable to computers, not to people. Research on memory conclusively shows that all the critical details, data, and analytics, are more effectively emotionalized and metabolized by the listener when they’re embedded in a story — and they become significantly more actionable.

Understanding Desirable Plush Toy Forms

Today, the class helped me with a post-it exercise in trying to understand what qualities were desirable in a stuffed animal to a seven-year old. Everyone was given four post-its of different color and asked to tag the ones (or split the post-it to tag multiple) that were bad, engaging, comforting, and enduring.

We discussed the qualities that made certain stuffed animals bad, engaging, comforting or enduring.

Bad: small, sad, gender-specific, stupid looking, too shiny/slick, scary, scratchy fabric, spiky, moldy

Engaging: not so rigid, something that can be mushed around a bit where the arms can be pushed into the body and pop back out, not “loud,” simple, has interesting features

Comforting: dogs, bunnies, floppy ears, huggable sized, meager expressions, relatable

Enduring: personal, dogs, bunnies, classic shapes that can be dressed up (e.g. bears)

The issue of whether to design in the cultural context or universal came up. Designing local and exporting those learnings to other situations would be ideal from a design perspective, but having a universal set of responsive toys would allow an NGO to stockpile them in advance of a disaster. If I design local, I need to find out what animals and toys are popular in Talca. Either way, I need to find ways of making the form customizable so that kids will know which one is theirs. This could be done through different clothing, color variations, accessories, etc. Even the One Laptop Per Child project had different colors available and the eyeglasses for children in Mexico project succeeded in part because the customizable options gave kids a say in what they wore.

I also need to get a better handle on what constitutes positive and negative feedback in the electronic component of the toy. Is aggression good (in providing that safe outlet)? How do children let out angst constructively? When should a parent be alerted? Should the toy only provide positive feedback (comfort and security)?

Overview of Trauma Psychology

Disasters often destroy the physical structures children rely on for their daily activities: schools, homes, places of worship, and places of play. This places a burden on children as they are generally unnerved by changes in the pattern of daily life. These structures are transitional objects. Children rely on them for ego function.

One of the most destructive effects of PTSD is the delay and damage to a child’s ability to engage in normal developmental experiences. Anxiety, withdrawal, regression, and difficulty concentrating interfere with a child’s participation in socializing and succeeding at school. Once a child has fallen off his developmental path, it is difficult to get back, even after symptoms of emotional trauma have been resolved. A child that is behind her social peers is likely to suffer rejection. A child no longer doing well in school may reformulate his self-image as no longer being a good student and stop trying. Catching up can be very difficult. Trauma also fosters defiant behavior. In turn, that behavior can increase the risk of further victimization and lead to a cascade of problems including depression, substance abuse, aggressive behavior, and problems with the law.

Steps in the Treatment of Traumatized Children

1. Parental guidance and counseling in parallel with child
2. Creation of a narrative of the traumatic event to desensitize the child
3. Safety planning with the child

There are several forms of therapy for PTSD in children. The most successful evidence-based forms are cognitive behavioral therapy (CBT) and art therapy. CBT views the child as an active, equal partner, who collaborates with learning tools towards recovery. It works well when the child wants to get better. Art therapy can be a more successful entry point into the foray of therapeutic options. Children who often have difficulty verbalizing their experiences after traumatic events. Play, drawing, painting, and sculpting is easier and provides a medium for exploring events and creating a joint narrative with the therapist. Children who won’t cooperate with CBT sometimes feel more comfortable engaging in art therapy because it provides an environment in which a sense of safety can be established.

Hosin, Amer A. Responses to Traumatized Children. Basingstoke England: Palgrave Macmillan, 2007. 1-65. Print.