Book Review – Posttraumatic play in children: What clinicians need to know

By Eliana Gil
2017
The Guilford Press

Eliana Gil’s gentle and sensitive approach to children and their families is evident throughout her book on posttraumatic play therapy. She calls her approach Trauma-Focused Integrative Play Therapy (TFIPT). Dr. Gil aims her book towards clinicians, mainly focusing on complex, chronic, and ‘unrelenting’ Type II traumas, which include multiple types of abuse and perpetrators, rather than Type I traumas (e.g., related to natural disasters or situations such as terrorism).

Dr. Gil differentiates between therapeutic “dynamic” play and “toxic” play. Therapeutic play eventually helps the child to progress, and allows to experience less anxiety when confronted with stimuli that are reminiscent of the traumatic event. Toxic pla,; however, reflects the child’s being ‘stuck’ and unable to gain from the particularly repetitive and harmful type of play.

Dr. Gil describes children’s posttraumatic stress disorder (PTSD) symptoms differs from those expected in adult behaviors and symptoms, and include dreams of monsters, repetitive play in which the trauma is reexperienced, regression to previous developmental states (i.e., enuresis, encopresis), as well as difficulty concentrating in school, somnambulism, headaches, stomachaches, relentless anxiety, and other symptoms.

In her book, Gil states that there are four types of posttraumatic play:

• Literal (playing out the traumatic events as they occurred),
• Symbolic (the child does not call the items by real names but the story is readily seen),
• Individual posttraumatic behavioral reenactments (replaying the traumatic experience when the child does not include others), and
• Behavioral reenactments in which the child attempts to enlist others to join the reenactment.

Gil’s example of the fourth type was when a child gave her a ping-pong paddle to hit her, “You like me, don’t you?” (p. 30). This type of reaction is typical of successful play therapy – it reveals notions held by the child and allows for new definitions. Here, the child was showing that when someone likes you, they will inevitably hurt you, lashing out physically.

The book is structured neatly into two main sections. Part I: Understanding Posttraumatic Play describes Gil’s clinical approach. Part II: Clinical Illustrations gives clinical examples of children and their families and the techniques and interventions used by Dr. Gil. Although clinical examples are provided throughout the book, the examples given in Part II are described in great detail. These descriptions do not replace direct training in play therapy, but they do offer a close description of what clinicians do during play therapy.

There are little gems every so often in this book. In the discussion of dissociation, Gil seems to imply that children dissociate on purpose, but ultimately describes it as a sign of system overload. She writes that children may eventually learn to not dissociate as much through gaining more impulse control. Some of these changes also happen through elimination of destructive and repetitive toxic play, and use of more constructive dynamic play.

Gil is reminiscent of the kindly supervisor who calls children “Pumpkin” and is able to interact with children in a way that not all people can. It is for this reason that although the book is well-written, and Dr. Gil knows her subject, there are limits in transmissibility. One important caveat comes from an example of a 12-year-old girl, where Dr. Gil’s intervention was, “I simply stroked her back.” (p. 61). As clinicians, we do not need to resort to physical expression, especially in cases of PTSD (but also in other diagnoses, such as the Pervasive Developmental Disorders, various personality disorders, affective disorders, and diagnoses such as Intermittent Explosive Disorder). In fact, a seemingly simple touch may be misinterpreted and may undo much of the work we may have put into a case. Here, the question becomes, “Was it the therapist’s own need that drove her to touch the patient? Was there a more effective intervention available to her?” Luckily for Dr. Gil, her touch was not viewed as a threat, possibly due to her (previously described) gentle grandmotherly approach.

I recommend this book for clinicians who are unfamiliar with or would like to improve their play therapy skills and would like to get a behind-the-scenes view through the eyes of a soft, intelligent, non-threatening grandmotherly figure. Many clinicians who have practices that examine family dynamics, could also gain from including play therapy in their repertoire. Play therapy is one of many useful techniques for engaging and ultimately communicating with children, especially about uncomfortable or traumatic topics.

Review by June Shapiro
June Shapiro PhD is a Clinical Neuropsychologist working in private practice for over 25 years.