We recently interviewed AZ+A’s mental health professional, Eliana Sigel-Epstein to learn more about psychotherapy, play, parent therapy and how she works with families. We learned she’s a wealth of knowledge and so much more!
What core theories/values guide your kids and families?
In many ways, I approach my work with children with the same underlying assumptions and values that I use in working with adults. I see relationships as being the most crucial context for growth and fulfillment. With children, I am curious not only about the child’s individual, unique sensitivities but also about the relationships around them. In particular, I focus on the most important relationship in a child’s life – that with her parent(s). For me, the vehicle to understand a child and help a child’s development progress is in the relationship between him and his parent(s).
I also pay close attention to the relationship between the client and me, whether that is a child, adult, or family system. I recognize that any help I attempt to provide will be useless if we don’t have a foundation of trust and mutual understanding. That means noticing my assumptions or biases, listening, and being curious about what the other person is communicating.
You mentioned that you focus on building a foundation of trust when working with any person, including adults. How does that work with parents?
I’ve found that focusing on the relationship is crucial when working with parents. Parenting can be riddled with both self-blame and societal blame. Our culture is never short on advice and judgments for parents but often lacks real concrete support for this incredibly difficult and important job. That blame is easily internalized and is usually quite acute when a parent feels challenged in the relationship with their child. Knowing that these doubts and anxieties are present before I even meet with a parent, I strive to create a space of mutual understanding between us. From here, we can properly see and hear what their child’s behavior is communicating and figure out how the parent and child can more effectively attune to one another.
Eliana, are there thought leaders or child development experts who inspire your work with families?
Theorists such as Donald Winnicott, Anna Freud, John Bowlby, Dan Siegel influenced my understanding of child development through a relational context. Stanley Greenspan and Serena Wieder, founders of the DIR model, also significantly affect my work. DIR provides a robust framework for promoting development through relationships and understanding the child’s individualities. All of my favorite theorists and child therapy practitioners advocate for the use of play as the primary way of engaging in therapy with children.
How does play help children work through mental health challenges?
As Greenspan and Weider say, children, and all of us, learn best through experiences. How many of us have been told to do something repeatedly, but not until we have done it and thought, “Hey! This is helpful!” do we actually integrate that advice into our lives. Play can provide that experiential learning with the addition of it being a joyful, pleasurable experience. This is particularly important for learning how to tolerate feelings, which is at the heart of most mental health challenges.
When children’s play involves themes of anger, aggression, loss, dependency, success, failure, power, and fear, they are experiencing those feelings in their bodies and learning how to tolerate them. When a child can handle emotions in their body, they can begin to think and talk about them and communicate those feelings to others. They can reflect on those feelings and problem solve. They will not be consumed or arrested by those feelings but can flexibly act or not act on them.
What are some specific examples of how play is used to co-regulate with a child?
This question reminds me of a moment I witnessed with a boy and his mother in a session. It was my first session meeting this elementary school-age boy, and, as I like to do in my first sessions, I invited his mother to join. About twenty minutes into our session, this young boy erupted in tears. As I understand it, he became overwhelmed by feelings of disappointment related both to present things and the culmination of blows that have worn on him for years. He collapsed into his mother’s lap on the couch, and she held him for some time, saying very little. I, too, said very little, silently holding the context of this boy’s grief in my mind. I was also curious to see how mother and son would navigate this situation together. I was impressed by the mother’s seeming acceptance of her son’s feelings and sensed that she was practicing restraint in trying to change how he felt about the situation.
The mom encouraged her son to share aloud what he was feeling, but all that came out were tears. After some time, she tried to suggest ways of problem-solving out of the sadness and feelings of defeat. However, the boy was not interested in figuring out something else to do other than lie in her lap. The mother was rubbing her son’s arm, and she began tracing her finger on his arm. He guessed a letter, and she said that it was correct. She continued tracing letters, and he continued guessing, spelling out his first name. Mom said, “You got it. Do you want another one?” The boy nodded. “Easy, hard or medium?” She asked. “Medium,” he replied. They played a few more times, the boy almost always correctly guessing each letter and then the entire word. The boy then got up, started bouncing on a trampoline, and talking about an upcoming birthday party.
Those intimate moments when you witness co-regulation in action are powerful! Thank you for sharing that beautiful story. What do you think it was about that game that made it effective for this child?
The mother later shared that they frequently played this game together, which prompted her to think of it. So, I think the familiarity of the game helped comfort the boy. But I also believe that their interaction was particularly effective for reasons that the mom probably wasn’t even aware of! First of all, when the boy began crying, the mom didn’t immediately try the game. She let him cry and simply held him. Once she sensed that the intensity of the feelings had run their course, she found a way to connect with him and co-regulate, using a game that was familiar to both of them.
An added benefit to this game was that it required minimal physical or motor demands; it only needed the boy to bring his attention to the subtle ways his mother’s finger was making contact with his arm. As he correctly guessed each letter and word, he felt competent in himself, which likely offset feelings of vulnerability in crying in front of an adult he had just met. In his grief, the boy couldn’t talk about his feelings with his mom or me. But he could play. His mother, understanding that, used that capacity to support their co-regulation.
You mentioned that the boy was elementary school-aged. How young is too young for psychotherapy?
There’s no such thing as being too young for psychotherapy! Children develop their inner experiences and ways of interpreting the world from birth. In the early days and weeks, that process is guided primarily through arousal states and satisfying basic needs. But as the baby develops, they are navigating a host of new sensations and experiences.
Are there specific techniques you use for infants and toddlers?
I trained in the model Child-Parent Psychotherapy before coming to AZ+A, which is particularly effective for infants and toddlers who have had early traumatic life experiences. I started with my youngest client at four months old! I administered treatment primarily by talking with the parent and reflecting on interactions with her baby. Child-Parent Psychotherapy has even been adapted to treat pregnant mothers (Perinatal Child-Parent Psychotherapy) as the parent(s) develop a relationship with their unborn child. Both Child-Parent Psychotherapy and Perinatal Psychotherapy can be critical preventative interventions to support development from the very beginning.
Thanks, Eliana, for sharing more information about your experiences and approaches when working with families.