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Created on October 31, 2024
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Transcript
Play therapy themes
Obser vations
Assesments
"Gianni Dont do that
"gianni SiT Down:"
Gianni , 3 yr 11 m
background info
Presenting issue
clinical impressions
strengths of client/family
identifying info
challenges of client/family
Dynamic Attential Span
Attends Well When:
Difficulting Attening when:
Observations
Independnet, creative has own ideas, minimal help
Warm engaged with clincian, invites her to play
nergetic, enthusiastic, and engaged in both structured and unstructured activities
An Dynamic Attential Sp an title
Difficulting Attening when:
If a flower isn’t blooming, you don’t blame the flower—you check the soil, the sunlight, the water. Children are no different
Home: .
- Nurter
- What will happen i she doesnt do chores?
- Growtt mindset priase the effort
- Model Vulnerability / Mistakes
- Peer Groups
- Postiive reinforcemnt
- Practice 2 step directionsAsk her to repeat instructions to ensure comprehension.
Teacher:
- Positve Reinforcemtn
- I love how you stayed with your art project and glued everything so carefully!” or “You waited so patiently for your turn—great job staying calm!”
- Breaks/Get up Allow her short breaks get up to which may improve attention in other tasks
- Sensory Integration Techniques: Use tactile materials in learning tasks to maintain her engagement.
- Teachers should respond promptly when Gianni seeks validation (e.g., “Ms. Marshall, look!”), so she feels seen and valued. Even a quick response—“I see that you’re working so carefully!
- Unconditinal positive regard
Treatment
Individual Play therapy
- Allow her to be a child
- Uncondional postive regard
- CONSITENCY
- Allow herself to make mistakes
- Role Reversal - Nurter/Nurtering
- Reflective Statements
- “You’re making sure the baby is safe and cared for. That’s so important to you.”
- “You’re making sure everything is okay after something bad happened.”
- “You’re inviting me to join your story. I can see how much you like sharing it.”
- Modeling Sharing behaviors/ providing support in classrroom
- Self-regulation strategies
- “While we wait for your turn, you can hold this fidget toy” or “Let’s practice taking deep breaths together while the others finish.”
Reliance on external validation--> Impact on self-wroth---> anxiety/self conciousness/ restlessness
Clinical impression
Gianni’s attention challenges appear linked to self-regulation difficulties. She frequently seeks feedback and engagement from others, relying on external cues to sustain motivation and remain engaged. Elevated anxious/depressed scores on the CBCL, combined with observed behaviors such as thumb-sucking and foot-tapping, suggest possible underlying anxiety Gianni’s strong memory and verbal skills reflect strong cognitive abilities, which enable her to participate meaningfully in conversations and tasks. These strengths can sometimes create a mismatch between her developmental capabilities and the expectations placed on her. Her play themes of caregiving and nurturing may reflect internalized expectations to meet adult-like standards, as she assumes roles of responsibility even during imaginative activities. Additionally, as an only child, Gianni also has limited opportunities for consistent peer interactions at home. Her frequent invitations for the clinician to “come over to play” and her reluctance to leave therapy sessions likely reflect a strong need for emotional and social connection. Impact on Attention and Emotional Needs:
- The expectation to act maturely and responsibly might limit opportunities for Gianni to fully engage in unstructured, childlike exploration and play, which are essential for her developmental stage.
- Over time, these responsibilities might shape her view of self-worth, making her feel she is only valued for what she can do rather than who she is.
- This role might contribute to her reliance on external validation, as she looks to adults for reassurance that she is "doing things right."
Living ArrangemntIt’s
- Lives with mom and dad in studo apt
- Low SES neighborhood in south LA
- Induced delivery, full term,
- Sleep challenges
- Last medical exam about a yr ago
- Babbling: 4M, 1st word: 4-6M, 2 word statements: 12M, Sentences: 1.5yr, Pull up/Crawling: 6M, Walking 1yr, Running: 14-15 M
- Mini Adult"
- August 2023- TCCI King San Pedro M-Fri 8-2pm
- None
- Close to moms friend daughter
Background
Family Dynamics
- Mom (23), Dad (39)
- "Everyithing is good"
- "full of love"Outdoors actiivies
- Dad works full
- timeParents started chores with her
- None
Play Therapy Themes
Doesnt allow herself to be a child
Rescue Activity
Adult Activity in Play
Nurturing in play
Difficulting Attening when:
Clinician
- Challenges with attention in unstructured activities/ no social reinforcement/engagement
- Seeks validation from adults.
- Sellf-consious / Sensitive to feedback
- .Difficulty. managing internal regulation without external support.
- Restless when waiting, tranisions or Low-Stimulation Moments:
- Has not developed social skills for sharing/cooperating with others
- Possible Anxiety
- Only child / limited peer engagement
- Family has missed 3 sessions
- Father can be guarded. Paints picture of "perfect" family
- Father works alot- (limited time at home)
Challenges
Parents:
- Does not ofllow two ste step directions
- Active at home unless you sit with her
- Difficulty get ting her to sleep
- Limited attention span, restlessness, and “always on the go."
ASQ
Teacher Report CBCL
Parent Report CBCL
Assesments
CBCL
Clinician
- Restlessness During Wait Times and Transitions:
- May struggle with understimulating/ standardized task completion tasks (cleaning) due to preference for engagigng in acitiiviies
- Often seek validation
- Has not developed social skills for sharing/cooperating with others
- Possible Anxiety
- Only child
Challenges
Parents:
- Does not ofllow two ste step directions
- Active at home unless you sit with her
- Difficulty getting her to sleep
Clinican
- Warm/Friendly
- Resilience
- Energetic Perssonality
- Empathy/ Social Awareness
- Strong creative thinking/imaginary play
- Problem solving abilities
- Strong expressive and receptive langugae akills
- Capacity to focus and finsinh tasks that are engaging, stimulating and interactive for over 15-20 mins
- Active Family - outdoor activities
- Both parents involved
Teacher::
- Gianni is very independent, helpful, & ready to assist.
- "always happy.”
- She is very observant & is curious about her personal surroundings.
- Very social and will play with anyone
Strengths
Parents:
- Independent/ Good adapative skills
- Good at variety of activities (painting, singing, dancing, running, & soccer.)
- Can iniate play with others
- Great memory
- "Likes to to mimic" and do what her parents do
- "Mini adult"
Ability to follow through
Disruptions in learning
Challenges in peer relationships
"Gianni constantly moves from one activity to the next " "She cant stay for longer then a minute on one thing! " "Shes always moving around!"
Functional Impaiments
Difficulty with 2-step directions
difficulties sharing
high activity levels
Presenting Concerns:
Referred by head teacher at TCCI- King San Pedro Presenting Concerns:
Gianni
- 3 yr 11M
- Hispanic
- Female
- English