Therapy Methods

My approach when working with children and families is dependent on assessment data, presenting issues, best practice
standards (i.e., modalities informed by research), and the training I have received. Below are the methods of treatment
you can expect from me.

Parent Education, Support & Training

When my kids become wild and unruly, I use a nice, safe playpen.
When they’re finished, I climb out. ~Erma Bombeck

Few, if any, experiences in life are more important to most of us than raising
healthy, well-adjusted children. Parenting brings joy and meaning to our lives
but can also be challenging and exhausting. This is especially true when par-
enting children with special needs or children who are experiencing difficult
life circumstances.

I generally spend ample time educating parents about their child’s disorder or
the circumstances causing their child’s distress. When parents have a thorough understanding of how these factors impact
the psychological functioning of their child, they are better able to understand why their child is displaying emotional or
behavioral problems. This knowledge empowers parents and better equips them to successfully help their child.

I also find value in helping parents reflect on their parenting style, attachment style, and their own families of origin. Forty
years of research has linked specific aspects of parenting style to several key outcome areas in child development. For
example, traits of high parental warmth, responsiveness and sensitivity balanced with maintaining reasonable expectations
of children is linked with children who understand and regulate their emotions well, display healthy self-esteem, and show
greater social-emotional competence (e.g., the ability to get along well with others, negotiate social conflicts, manage their
emotions). Adult attachment style is also predictive of how parent’s view and feel toward their children and is worth ex-
ploring. There are, of course, many factors beyond parenting and attachment style that impact the mental health of chil-
dren, but when parents explore these factors they sometimes can make changes that help their children.

I often spend time teaching parents specific strategies designed to address their child’s disorder or the situation causing the
child’s distress. In alignment with child development and parenting outcome research, I recommend strategies which in-
volve strengthening the parent-child relationship and focus on positive methods of engagement and discipline. In many
instances misbehavior can be viewed as a child trying to get his or her needs met in an ineffective manner. It’s helpful to
discuss ways in which parents can respond to their child’s emotional and behavioral problems that will teach their child
healthier ways to get his or her needs met.

Parenting foster and adopted children with maltreatment histories is particularly difficult, especially when children have
experienced chronic or long-term maltreatment. In such cases I help parents deal with acting-out behaviors (e.g., anger
outbursts, defiance, passive-aggressive behaviors such as lying and stealing) as well as children who exhibit insecurity
and chronic anxiety (e.g., worrisome, clinginess, fearfulness). I help parents identify and respond to their child according
to their child’s developmental age, and I educate parents about communication, daily interactions, and play behaviors they
can use to facilitate healing and develop a more secure parent-child relationship. I also explore with parents effective be-
havioral management strategies and work on structuring the home environment to decrease or prevent some of the prob-
lems from occurring. Parenting / caregiver programs in which I am trained and often refer to include Circle of
Security™, Hughes’ model of Attachment-Focused Parenting, Conscious Discipline®, and Trust-Based Relational
Intervention®.

Copyright® 2018: Greta Zuck, PhD, LPCS, NCC, RPT-S

Infant/Toddler Mental Health Therapy

Whenever I held my newborn baby in my arms, I used to think that what I said and did to
him could have an influence not only on him but on all whom he met, not only for a day
or a month or a year, but for all eternity - a very challenging and exciting thought for a
mother. ~Rose Kennedy

It is hard to believe that emotional development in infants was uncharted territory until
the 1930s. To that point experts did not uniformly believe that infants experienced emo-
tional pain or were negatively affected by it. Modern infant research shows that infants
have a rich emotional base from birth onward, and that infants who experience early envi-
ronmental adversity (e.g., medical trauma, unresponsive parenting, child maltreatment)
are at-risk for developmental delays, particularly delays in social-emotional development
and problems related to parent-child attachment. Many infants and young children recov-
er when risk factors are removed, but some do not fully recover and struggle with social-
emotional developmental tasks.

A well-established method of mental health care for infants is Infant-Parent Psychotherapy created by Dr. Selma
Fraiberg in the late 1970s. The infant-parent relationship is the focus of treatment, and the method focuses on addressing
parents’ own unresolved psychological problems which interfere with parents developing a healthy relationship with their
infants. In other words, there is often a trans-generational transmission of mental health problems (such as attachment
style) passed down from parent to infant. Through working directly with parent-infant dyads, the goals of treatment are to
help parents become consciously aware of unhelpful interactional patterns, modify misperceptions and mistaken beliefs
they may have about their infants, develop empathy toward their infants, and develop a mutually satisfying relationship
with their infants.

Dr. Alicia Lieberman’s Child-Parent Psychotherapy is heavily influenced by Fraiberg’s work. The model is a relation-
ship-based form of treatment for parents of children up to age five which integrates psychoanalytic and attachment theory
with intervention strategies from cognitive behavioral and social learning theory. Treatment involves joint play sessions
with parents and children. During sessions the therapist translates the developmental and emotional meaning of the child’s
behavior to the parent similar to the work done in Infant-Parent Psychotherapy. In doing so, parents often develop a new
understanding of their child. The therapist may also provide teaching and role-modeling to parents (e.g., how to engage in
protective parent-child caregiving, helping parents become aware of their own trauma triggers which interfere with care-
giving, crisis intervention planning, etc.)

Within the last ten years a few additional innovative research projects and early intervention programs have been devel-
oped for young children who have experienced early adversity and interpersonal trauma. Such programs have been creat-
ed for birth, foster and adoptive parents caring for young children, infancy through approximately age five. Two programs
are described below.

The Circle of Security™ treatment model was developed by doctors Kent Hoffman, Glen Cooper, and Bert Powell of
Spokane, Washington. Circle of Security™ emphasizes teaching caretakers the basic tenants of attachment theory. Parents
are taught to recognize and sensitively respond to their young children’s needs using detailed graphics and video-based
training. The model implements decades of attachment research in a step-by-step process for use in parenting groups,
home visitation, and individual counseling. In 2016 I completed the 4-day Circle of Security® Parenting™ (COS-P) train-
ing program and became a Circle of Security Parent Facilitator.

Led by Dr. Mary Dozier of the University of Delaware, Attachment & Biobehavioral Catch-Up is part of the Infant-
Caregiver Project. Biobehavioral Catch-up aims to help primary caretakers understand and sensitively respond to their
infant’s emotional needs. There is an emphasis on responding to young children even when they ignore or reject parental
attention and helping parents to consistently nurture their children even when it does not come naturally for them to do so.

Copyright® 2018: Greta Zuck, PhD, LPCS, NCC, RPT-S

I’ve had the good fortune to attend presentations and trainings by doctors Alicia Lieberman, Robert Marvin, Kent Hoff-
man, and Mary Dozier over the years. I typically use components of these four models when I work with caretakers of
children from birth to age five who are in the foster care system as well as parents who have adopted children. The Cali-
fornia Evidence-Based Clearinghouse for Child Welfare rates these programs as supported by research evidence. Attach-
ment and Biobehavioral Catch-Up rates at a Level 1 (Well Supported), Child-Parent Psychotherapy rates at a Level 2
(Supported) and Circle of Security rates at a Level 3 (Promising Practice).

Play Therapy

The beloved American pediatrician, Dr. Benjamin Spock, is quoted as saying,

“A child loves his play, not because it’s easy, but because it’s hard.” This state-
ment encapsulates Spock’s training in psychoanalysis and his belief—revolution-
ary during his time—in the critical importance of the emotional lives of children
and the function that play serves in processing difficult feelings and life events.

Over the last fifty years play therapy has evolved to become one of the most fre-
quently chosen methods of mental health treatment for children. Children, par-
ticularly those under the age of ten, lack the abstract language ability and cogni-
tive development necessary to benefit from traditional talk therapy. Play is their
natural medium for self-expression, coping, and problem-solving.

As a Registered Play Therapist Supervisor since 2008, I am trained to engage children in a variety of play therapies that
cover a range of presenting issues. Play therapy is not a singular model of treatment; rather, it is a model that uses differ-
ing techniques based on the theoretical orientation being applied. I tailor the play therapy approach I use to the individual
needs of each child and family I service. Below is a description of the orientations I use.

Client-Centered and Filial Play Therapy

Child-centered play therapy is one of the most popular methods of play therapy used to-
day. The client-centered approach to psychotherapy was originally created by psycholo-
gist Dr. Carl Rogers, and Dr. Virginia Axline refined the method in the 1950s in her work
with emotionally disturbed children. Client-centered play therapy is a relationship-based
method of treatment which posits that children are able to psychologically grow and
change for the better when a safe and accepting environment free from agenda, direction,
and constriction is provided for them. This type of play therapy allows children to freely
express themselves—their conscious and unconscious thoughts, feelings, and actions—
through the use of carefully chosen toys and art supplies.

During client-centered play therapy specific toys are present which allow children to ex-
press and process a variety of emotions (e.g., toys for nurturing, acting out aggression,
developing mastery skills). Children are free to play as they wish while therapists closely
track and verbally reflect back to children what they are doing and the feelings they are expressing in their play. Doing
so helps children feel understood and validated in the context of a safe and trusting relationship.

Parents can learn client-centered play therapy to use at home. This play method, originally developed by doctors
Bernard and Louise Guerney in the 1960s, is referred to as Filial Therapy. One effective filial model, developed by
Dr. Garry Landreth, is Child Parent Relationship Therapy (CPRT). Teaching parents how to therapeutically play
with their children is a highly effective way for parents to build more connected and fulfilling relationships with their
children. The play sessions provide an opportunity for children to get their emotional needs met which, in turn, often
leads to improved communication, better emotional control, and more cooperation from children outside of play ses-
sions. CPRT is a well-researched parenting model with numerous studies investigating its effectiveness and the major-
ity showing statistically significant results and moderate to large treatment effects for the superiority of CPRT over
control groups.

Copyright® 2018: Greta Zuck, PhD, LPCS, NCC, RPT-S

 The mother of a former client comments on using filial therapy with her 7-year-old son, with whom she was experi-
encing defiance, anger, and tension in their relationship:

“Learning how to play with my child in therapy has completely changed our relationship, but it took me a while
to buy into it. At first I was uncomfortable with him having so much control of the play. I felt like just an observer
sitting there watching and verbalizing what he was doing, and it seemed strange and pointless. But after several
sessions he began to ask me to play more with him. After a while I got used to completely following his lead and
letting him be the boss when he played, and then his play changed—he then seemed to work through a lot of heavy
feelings in his play. It makes sense that this may have been a result of me backing off and giving him the space
and control he needed to totally be himself. I think he felt like I was really beginning to understand him and ac-
cept him. At home he became easier to be around, and he seemed happier.”

I most often use client-centered play therapy with young children suffering from developmental delays, low self-es-
teem, depression, and adjustment difficulties. I frequently teach parents filial therapy when there is a conflict in the
parent-child relationship or when parents desire to improve their relationship with their child.

Psychoanalytic Play Therapy

The origins of psychoanalytic play therapy belong to psychoanalysts Dr. Anna Freud
(daughter of Dr. Sigmund Freud, founder of psychoanalytic theory) and Melanie Klein.
This play method attempts to holistically understand and appreciate children by provid-
ing a safe and accepting environment for them to explore their thoughts and feelings
through symbolic play. Children re-enact difficult life situations through play while ther-
apists provide a psychological “holding” environment for them by empathically listening
and allowing children to project their difficult thoughts and feelings onto them. In doing
so, children’s defenses to their emotional pain are respected and they are able to main-
tain a safe psychological distance from their troubles.
Psychoanalytic play therapy provides an environment similar to client-centered play
therapy, but differs in that psychoanalytic theory asserts children require encouragement
and direction from therapists to confront painful thoughts and emotions. Therefore, dur-
ing psychoanalytic play therapy, therapists gently confront and interpret children’s play
behaviors in an effort to help them clarify and understand their problems and develop greater self-acceptance. I often
use psychoanalytic play therapy when working with children struggling with loss, depression, anxiety, and children
coping with major life changes.

Object Relations Play Therapy

It is in playing, and only in playing, that the individual child or adult is able to be cre-
ative and to use the whole personality, and it is only in being creative that the individual
discovers the self. ~D.W. Winnicott

Object relations play therapy incorporates object relations theory and attachment theory.
This developmental treatment model integrates the work of Melanie Klein and doctors
Donald Winnicott and Margaret Mahler. Objects relations theory posits that early interac-
tions between infants and their caretakers become internalized, forming mental templates
that filters the view infants have of themselves, others, and their world. Thus, this play
method is often used with children who have experienced significant trauma and mal-
treatment during their first few years of life. Such children often develop rigid, disturbed
internal working models and have trouble trusting adults and their environment. This
leads to difficulty in trust and attachment (i.e., connecting positively with others, receiv-
ing and accepting nurturing) and emotional regulation.

Copyright® 2018: Greta Zuck, PhD, LPCS, NCC, RPT-S

 The goal of object relations play therapy is to help children develop a more positive internal working model and a
more secure style of attachment. Using both non-directive and directive play in a highly attuned, developmentally
sensitive, and invitational manner, therapists confront and challenge unhealthy themes in children’s play. Through this
approach a “secure base” is provided for children in the play room which assists them with building trust in adults,
encouraging their receptivity to nurturance while decreasing their defensiveness.

I often use this model of treatment with children who have experienced early relational trauma and parental loss, such
as children in foster care and adopted children.

Theraplay®

Invented by Dr. Ann Jernberg in the late 1960s, Theraplay® is a directive,

specialized form of developmental play therapy based on attachment theory,
object-relations theory, and self-psychology. Theraplay® consists of play-
based activities designed to facilitate healthy parent-child relationships in a
playful atmosphere of empathy and attunement—eye contact, gentle touch,
close physical proximity, sensory motor stimulation, and rhythmic move-
ments are used. Further objectives are to help children develop a positive
sense of self, improve their ability to be self-reflective/self-aware, and im-
prove their ability to feel more secure in relationships.

Emerging research indicates that Theraplay® provides high levels of stimula-

tion to the brain structures involved in emotional regulation and regulatory processes. Although originally developed
for high-risk children and their caretakers, Theraplay® has since been adapted to work with foster and adopted chil-
dren, children with autism and other pervasive developmental delays, children with selective mutism and other anxi-
ety disorders, and children with fetal alcohol syndrome.

Training by the Theraplay Institute in Chicago is available for clinicians who wish to use the method. I attended the
standard 4 day training, Level 1 Theraplay® and Marschak Interaction Method in 2006 and Level 2 Theraplay® in
2017. I use Theraplay often with adoptive families. The California Evidence Based Practice Clearinghouse for Child
Welfare has given Theraplay a scientific rating of Level 3 (Promising Practice).

Expressive Play Therapies

Rather than healthily expressing their difficult feelings children may act their
feelings out (e.g., tantrums, defiance, hitting, toileting issues) as well as hold
their negative feelings in (e.g., depression, self-injurious actions, somatic
symptoms). Expressive therapies involve the creative use of music, writing,
movement, art, and drama to provide children with a non-threatening outlet
for self-expression and the expression of emotions. Both directive and non-di-
rective approaches are used to encourage children to express themselves in
both verbal and non-verbal ways. I often use expressive art therapies with chil-
dren who have difficulty with self-expression and children who have a natural
desire to express themselves using music, writing, drama, or art.

Copyright® 2018: Greta Zuck, PhD, LPCS, NCC, RPT-S

Therapeutic Stories: Narrative Therapy, Bibliotherapy, and Lifebooks

Narrative therapy and bibliotherapy techniques are based on the belief that we
make meaning of our lives through the stories we hear and tell. Books and sto-
ries can illustrate various problem situations relevant to children in either direct
or metaphoric language. Most children easily relate to characters in stories and a
dialogue can then open in a non-threatening way to discuss difficult situations
children experience. Stories are particularly useful when children have difficulty
understanding and expressing their feelings, and they also are helpful when pro-
viding mental health assessments since children project their own needs and ex-
periences into their understanding of stories.

I use bibliotherapy and narrative therapies often with children struggling with
major life changes such as divorce, blended families, school-related challenges, and behavioral challenges. With foster
and adopted children I often create a Lifebook which is a unique story constructed to provide children with an orderly,
cohesive narrative of events in their lives (e.g., facts about their birth, their birth family, why and how they were removed
from their birth family). Lifebooks help children make sense of their lives, reduce magical thinking, and correct distorted
ideas children may have about themselves and their birth families.

Cognitive Behavioral Play Therapy

The cognitive behavioral model is used frequently in the mental health field with individuals of
all ages with various presenting problems. The model, originally developed in the 1950s by
cognitive theorists doctors Aaron Beck, Albert Ellis, and Donald Meichenbaum, asserts that it is
not events that cause negative feelings and outcomes; instead, negative feelings come from our
appraisal and belief systems about ourselves and events. They posit we often feel badly about
ourselves, others, and situations due to distorted, irrational, or unhelpful belief systems that
we’ve developed and are maintaining. These beliefs become internalized and cause us to feel
and behave in negative ways. Thus, the goal of cognitive behavioral therapy is to change mal-
adaptive thinking patterns. The Greek philosopher Epictetus summed up the essence of cogni-
tive therapy well by stating, “What disturbs men's minds is not events but their judgment on
events.”

Cognitive behavioral therapy joined with play therapy in the late 1980s, beginning with psy-
chologist Dr. Susan Knell. Dr. Knell began modifying adult cognitive therapy techniques by
using developmentally-based play methods of engagement with children to help them modify maladaptive thinking pat-
terns. Cognitive behavioral play therapy uses directive and structured techniques to teach children how to identify and use
positive self-talk, identify and refute negative or helpful thought patterns, and teach children how to cope with stressors.
Skills are taught, modeled, and role-played in sessions using puppets, bibliotherapy, narrative therapy, and games.

I often use cognitive behavioral play therapy for children experiencing depression, anxiety, chronic worry, and insecurity.
I’ve also been trained in Trauma-Focused Cognitive Behavioral Therapy, an evidence-based treatment method for chil-
dren who have experienced significant traumatic events such as sexual abuse. Treatment includes psychoeducation, teach-
ing emotional regulation and coping skills, and completing a trauma narrative with children (i.e., gradual exposure to de-
crease trauma symptoms)

Copyright® 2018: Greta Zuck, PhD, LPCS, NCC, RPT-S

Skills Training: Social Skills, Anger Management, Coping Skills

Many children with social-emotional problems, mental health conditions, learning

disabilities, and processing problems benefit from direct skills training. Not all
children intuitively understand, for example, how to behave in socially acceptable
ways with their peers. Some children may not have been taught or modeled accept-
able social behaviors. Other children may have had adequate teaching and expo-
sure, but may have difficulty accurately reading, processing, and responding to so-
cial cues as with children who have Non-Verbal learning Disorder or Autistic Spec-
trum Disorder. Some children may simply be excessively anxious in social situa-
tions causing them to have impairment.

Some children—both with and without mental illness—have difficulty regulating strong emotions such as frustration,
anger, and anxiety. These children often benefit from learning to label their feelings, identify their triggers, and develop a
realistic coping plan for themselves. Furthermore, many children will benefit from learning how to systematically relax
and calm their minds and bodies. There is a growing body of research validating the benefits of such mind-body work.

I utilize a variety of interventions when engaging in skill building with children. Therapeutic board games and activities
are often useful for practicing and rehearsing skill sets. Such games often operate from a cognitive behavioral orientation
and children are required to use positive self-talk, refute unhelpful thoughts, or practice coping techniques during game
play. Behavioral modeling and role-play are also beneficial. For instance, children may watch their parents and I act out a
challenging scenario with dolls, puppets, or ourselves as the actors. After observing, children participate as actors in sce-
narios, practicing appropriate ways to socially engage, handle anger, etc.

Meditation, Mindfulness, and Yoga

Over the last few years neuroscience has informed us that there is value in learning to regu-
late stress and challenging emotions by learning meditation and mindful techniques, and
emerging research shows positive results. Meditation and mindfulness can help with physical
problems, emotional problems, and coping with life stressors.

I utilize techniques from Jon Kabat-Zinn’s Mindfulness-Based Stress Reduction (MBSR)

program, a method of using meditation and yoga to cultivate awareness and reduce stress. It
is based on the ancient practice of mindfulness, which involves present moment awareness,
deep relaxation, and gentle movement. Through mindful meditation children learn to con-
sciously observe their reaction to stressors before responding. Those who practice MBSR re-
port an increased ability to relax, greater enthusiasm for life, improved self-esteem, and in-
creased ability to cope more effectively with stressful situations.

I also incorporate yoga when I believe it will be helpful for the children I service. I became a certified children’s yoga in-
structor in 2012 through YogaKids® International, Inc. after completing 200 hours of Yoga Alliance approved training.
Please visit the “Yoga for Children” link under “Services”on my website for more information.

Parents can access many free and low cost apps and downloads to help children learn breathing techniques, visualization
and guided imagery, progressive muscle relaxation, and other techniques to positively manage stress. Over 1,500 free au-
dio and video recordings can be found online at Mindfulness Exercises at: https://mindfulnessexercises.com.

Copyright® 2018: Greta Zuck, PhD, LPCS, NCC, RPT-S

Family Therapy

Family systems theory proposes that an individual’s psychological problems can de-
velop and be maintained in the context of family functioning. Family therapy focuses
on exploring the interactions that occur among family members and how these inter-
actions may be reinforcing problematic beliefs, feelings, and behaviors in family
members and the family as a unit.

I find family therapy to be especially useful in families experiencing conflicts passed

down generationally, as well as for families experiencing situations involving major
life changes (e.g., divorce, new baby, blended families).

Family therapy is a useful model to use with adoptive families, especially with older
adopted children. Issues in adopted children who have experienced maltreatment prior to adoption often impact not just
the child, but the entire family system, including the parent-child relationship, other children in the family, and marital
relationships. Children who have experienced maltreatment and multiple changes in caregivers often have a very different
view of a family than do children born into stable, loving families.

Family therapy can serve to safely explore the dysfunctional beliefs and behaviors that such children have developed and
may be maintaining within their new adoptive families. In 2001 I completed a 4 day training with Dr. Daniel Hughes in
his model of care, Attachment Focused Family Therapy, also knows as Dyadic Developmental Psychotherapy when
used with adoptive families. This family-based approach involves teaching parents to employ an attitude of playfulness,
acceptance, curiosity, and empathy when addressing their children’s emotional and behavioral problems which are rooted
in the parent-child attachment relationship. Parents are taught the critical skills of how to use affective-reflective dialogue
in communication with their children, manage their children’s sense of shame, understand the disrupt-repair cycle in par-
ent-child interactions, and consider their own attachment style.

Eye Movement Desensitization and Reprocessing

Eye Movement Desensitization and Reprocessing, also known as EMDR, is a
method of psychotherapy developed by psychologist Dr. Francine Shapiro in 1989
to address the distressing symptoms associated with traumatic and adverse life
experiences.

Treatment works by accessing memory networks in the brain which store disruptive
or traumatic experiences. Traumatic memories (i.e., inadequately processed memo-
ries and their associated images, thoughts, emotions, and physical sensations) are
re-processed using a therapeutic technique called bilateral stimulation. Through the
unique processing of EMDR, troublesome memories are desensitized, insight
emerges, and a shift in consciousness allows for new learning and experience.
Traumatic event and memories are not erased; rather, they have been redefined and
cease to hold power and control over the individual.

Research supports the effectiveness of EMDR for children and adults who have ex-
perienced life events which cause traumatic stress, generalized anxiety, depression,
phobias, grief/loss, and attachment trauma.

EMDR is used across the globe and has gained significant validity over the last decade. Over 30 randomized controlled
trials now support effectiveness, and EMDR is endorsed as an effective treatment by the World Health Organization
(WHO), the American Psychiatric Association, and the Department of Veteran Affairs. In 2017 I completed Basic Training
in EMDR through the EMDR Institute, which includes 4 days of instruction taught over 2 weekends.

Copyright® 2018: Greta Zuck, PhD, LPCS, NCC, RPT-S