In my last blog (January 2018) I introduced you to Billy, an eight-year-old boy, who had experienced frightening and unpredictable childhood trauma and neglect. As a result, his brain was operating from a hyper aroused defensive position. I wrote that his brain frequently operated from the limbic and brain stem area causing him to swing into dysregulated trauma responses to his current environment, relationships and capacity to learn.

Billy and I worked together for 12 months using dramatherapy to help integrate his brain and implicitly held memories so that he could respond to current life experiences from a regulated place of being.

Our first task in supporting this was to support Billy to develop an emotional language and narrative for his experience.

Billy asked if we could play Emotional Bingo. This game has emotions depicted with a picture and a word, as you turn a card over if you have the emotion on your bingo card you cover it with a counter.

The use of games in therapy helps:

• the negotiation of difficult experiences that leads to mastery of stresses and traumas
• the motoric release of feelings and action
• the special relationship and rapport that develops with the therapist

Dramatherapists tend to look at games as a way of the client dramatically projecting and engaging with their internal world, at a distance which feels safe. Billy had an insecure and anxious attachment pattern, his feelings often felt overwhelming and he described his brain as ‘dying’ when things became too much. I wondered if his brain went into ‘freeze’ mode which may have been a repeat of his early trauma response to his overwhelming and confusing home life and experiences. Playing Emotional Bingo, enabled Billy to start to notice and name how he was feeling in response to our playing together. At times he was surprised at what he noticed, at the end of one of our sessions he picked up the ‘guilty’ card and told me that this was how he was feeling but that he did not know why, in a later session when leaving he picked up ‘angry,’ and ‘disappointed’. I wondered if in beginning to notice and name feelings in the here and now encounter we were also learning to recognise older more implicitly informed experiences belonging to Billy’s earlier life.

In infancy our capacity for understanding our self is shaped by the quality of interactions with our carer, by touch, gaze, through the use of symbols and then through the use of language. A child learns to understand and manage their internal experiences and place in the world through these numerous interactions. Billy had not experienced this in his early life. The parts of the brain which are most affected when this is absent are the pre-frontal cortex and the limbic system. The pre-frontal cortex helps us think, have empathy and manage feelings and the limbic system is where we hold our ideas about emotional safety and relationships. In therapy Billy was beginning to name experience, develop empathy and experience a safe and trusting therapeutic relationship.

The more relaxed Billy’s brain became the more he could think about how it might be working and what was happening when it wasn’t working. He also began to imagine what I might be feeling, picking Emotional Bingo cards for me and starting to notice our differences and similarities. We thought about how our brains worked and what happened when they felt frozen or overwhelmed.

To this end we used a marble run game, constructing a two-foot high structure of connected tubes with different blockers, pacers and enhancers in. We thought of this structure as the connection between the body and the brain, our marbles became our neurons firing through the brain. We noticed what happened when the brain became hyper aroused by overloading it with marbles, we noticed what happened when we placed marbles in slowly and then filmed it on a slow-motion camera setting, we noticed what happened when the marbles went in in a paced regulated manner. We continued to explore this over several sessions, I added some explanations around attachment, trauma and neuroscience at a pace I felt Billy could manage. Listening to these explanations Billy decided that, using the marble run, he would make a short four-minute film, entitled ‘Me and my Amazing Brain”

Alongside this, he started talking about his amazing brain on a weekly basis, noticing what he was managing at school and in relationship with his peers. He also began to understand when he started to become overwhelmed. I recommended a Sensory Attachment Assessment so that the system around Billy could also think more about his amazing brain and how to keep supporting and developing its growth.

At the end of Billy’s dramatherapy he asked that we make a certificate about his amazing brain and that he got to keep the four-minute film, Billy’s relationship with his brain was a long way from where it had started in those initial dramatherapy assessment sessions.

Sarah Mann Shaw

April 2018.

 Comments/feedback and observations on my work are always welcome – please feel free to message me.