Using Board Games, Breaks and Potential Space in a Session with a Latency-aged Child
Andrew Guthrie, Ph.D., TCPP dipl.
A child in early latency returned after a two week break from therapy in a rambunctious, engaged, slightly angry and eager mood.
Sometimes in therapy board games are used to put the child at ease, create or maintain rapport, and to observe how the child manages or can not manage established rules of the game. Board games can be considered a form of psychological testing that evaluate the child’s self esteem, frustration tolerance and affect regulation. Most children that I see are delayed in their emotional development due to experiences of often extreme forms of trauma and loss. Thus, many of these children enjoy board games without being capable of following the rules, falling behind or losing. These children have lost so much in their lives already, and their self-esteem and ability to tolerate the temporary reduction in self-esteem that can accompany losing a game is so fragile and limited, that winning a game in omnipotent fashion may actually help a child recover desperately-needed feelings of worth and competence. And so, in therapy the therapist can let the child cheat to feel better about themselves, while choosing moments to playfully and calmly voice what is happening, i.e. “You just hate losing don’t you? How does it feel when I’m ahead? or “You can’t stand it when I win, can you? That’s okay. Sometimes I can let you win and help you feel better.” Over time, this often leads to the restoration of the child’s self esteem, losing becomes more tolerable once the child feels like they have something, and cheating may cease.
Understandably, following a break from therapy my little patient was needing to get more from me than usual, or was needing to feel better right away, and so her need to cheat was the dominant theme in the game. The intensity of her need was a bit uncharacteristic, but seeing how much she needed the emotional experience in this session of winning, dominating, and feeling good, I allowed it and bided my time while looking for a way to get something across to her about what I thought she was feeling.
I could do this via words, either my own to my patient, or from my character in the game to hers. I could intervene in play or reality, depending on what I felt could be most helpful, most possible, and least disruptive to my little patient’s still-fragile sense of self and still-limited capacity to think about her feelings about our break from therapy. If I stated to her that perhaps she needed to win more today because she didn’t have therapy for a while, which could make her feel powerless, sad, and evoke a sense of loss and shame, this would certainly have fallen flat with this (and most) six year olds.
Perhaps I could have approached this idea in a brief and playful way: “We missed last session and now you’re the boss of me aren’t you!” Instead, I just waited, not feeling like I had to say anything or respond to the obvious dynamics in this session, but prepared if a moment emerged where I could fit my thoughts into the stream of her own.
This moment did arrive when the game ended and my patient took her character and began pretending to gobble up all of the food on the game board as if she was ravenous. She was saying, “I’m so hungry!” which could be interpreted as “I’m so needy!” but obviously she was just referring to her character’s hunger and not her own potential emotional hunger or neediness. I was in a playful and risk-taking mood, so without thinking I responded, “We missed last week,” to which the patient responded back, without missing a beat, to my amusement and slight shock, “I know! That’s why I’m so hungry!!!”
How can we begin to understand what happened in this moment? Did my patient understand that I was referring to her emotional neediness and hunger associated with the break from therapy? Very likely not, although she seemed to understand on some level that her actual hunger in the game emerged from her experience of missing therapy. Measured, tentative risk-taking in how I intervene with a patient can lead to moments of wonderful spontaneity and growth, and often shocking responses from my little patients in particular.
As my patient was playing with her character, greedily and with great need gobbling up the food on the board game, my intervention technically broke or interrupted the symbolic aspect of her play, since I introduced the reality of the missed session, and implicitly made a connection between this event and her current play. In the past when I had introduced reality - when she was playing but also when she was not playing - she would usually ask me to stop talking and “just play.” Sometimes she would get very upset or become angry with me, while other times my ideas were simply ignored. For my patient, reality was experienced as too threatening, or too “real,” her feelings were confused and overwhelming to her, and so play and the trusting, not scary relationship that was developing between us was definitely the therapeutic “thing” for this (and many other) six year olds.
But still, I stubbornly continued to look for creative ways to inject small and manageable doses of reality into the play when I thought it could be helpful. This constitutes a necessary risk that the therapist must undergo, often balancing on an edge between what is safe and useable, or consumable, by the patient and what can overwhelm their capacities, in order to facilitate understanding, intimacy and change.
And so, when I spontaneously said, “we missed last week,” and my patient responded, “That’s why I’m so hungry!” you can imagine my surprise and my pleasure at having cooperatively bridged playing and reality, or the symbol with the thing itself. One idea about “where” this intervention belongs and why it was effective is the psychoanalyst and pediatrician Donald Winnicott’s notion of potential, or transitional space. This space is an area of experiencing that is neither just play or reality, but somewhere in the middle, composed of both aspects. It is an area that is neither just subjective (play, fantasy) or objective (reality) but a gray area in between where play and reality can overlap and take on qualities of the other. It is the space of play, creativity, art and culture.
Perhaps this intervention worked with this patient because it existed in a potential space that was not too real or too fantastic. I was not referring just to the missed session or just to the hungry character in the play, but to both. Although the statement I made was real and referenced reality, something about it was perhaps just playful enough, or just close enough to a transitional area of experiencing that inhabits the space between fantasy and reality, that it could be used by the patient. It was not too scary, real or overwhelming, but perhaps “just right” and facilitating of the patient’s just-burgeoning capacities to recognize reality and its connection to playful fantasy and symbolism. The intervention intersected with the patient’s capacities and readiness for recognition in a potentially optimal way, forwarding her growth and therapy.
Underlying this intervention is my recognition that the break from therapy was far from easy for my patient and that she had struggled emotionally. After observing her for some time in this session I managed to feel myself into her experience. I empathized, understood, got something about how she was feeling and why, and these acts appear to be therapeutic and enable psychological growth and change, perhaps because they provide the patient with an experience of being known and thought about that the patient had not experienced before. It feels good to be gotten – very good. Being gotten by someone may enable one to “get” themselves. This may lead to the capacity to empathize with the self, or self-knowledge, which can extend to an enhanced capacity to manage one’s feelings – the primary problem in regulatory disorders such as ADD, ADHD and ODD.
This moment in one session occurred in one day along with many other beautiful moments of intersubjective meeting and potential change with my child and adult patients. Psychoanalytic work is chock full of moments like this which are so meaningful and beautiful, which does explain why I love this work. Over time I hope to “get” this work more and more, but there is no denying that I have been “gotten” by it.
