Episode 017 Clair Mellenthin
00:00:00 T. Heath: Hello, everyone. Welcome back to the Therapist Confidential podcast. I am your host, Travis Heath, and today we get the pleasure of speaking with Clair Mellenthin, a play therapist. Probably more than just a play therapist, though. We'll get into this. Can you work with kids without really working with families? So maybe a family therapist, a a therapist of parents, a therapist of systems. I'm really looking forward to see where this conversation may take us today. A quick reminder, if you haven't already, on Apple Podcasts or Spotify or YouTube, there's probably other stuff we're on that I don't know if you can give us the thumbs up or the like or the review. All those good things are really helpful in getting the word out about the podcast. All right, Clair, welcome in. How are you doing?
00:00:43 C. Mellenthin: Good. Thanks so much for having me. I'm so thrilled to be here.
00:00:47 T. Heath: I'm excited that you're here as well. I'm wondering if you can begin by just telling people who may not be as familiar with you a little bit about yourself, your history and how you got to this place and doing the work you do.
00:00:58 C. Mellenthin: Yeah, so I have been in the field of therapy. I'm at this crazy milestone in life where I've been doing this longer than I haven't, which is a weird place to be in.
00:01:09 T. Heath: I hear you, I'm getting to that place too. It's very strange.
00:01:13 C. Mellenthin: It's so weird. Middle age is amazing. Um, but I. I'm so lucky to have a career that I just genuinely love what I do in all the different parts of it. And I've been working in the field of play therapy, since my early twenties. And so, you know, most of my adult life has been in some capacity within this world of play therapy and, and within this time continuum. I've also developed a practice model called attachment centered play therapy. And this is a family systems based, attachment orientated practice of play and it's so fun. Like watching this just blossom. Um, you know, it's been translated into Korean and Chinese and I've been able to kind of go across the globe, training therapists and how to work with family systems and especially like where my, my passion and my expertise is, is the impact of trauma on families and helping to repair and restore and sometimes build for the first time, a sense of security within the attachment relationship. And so on top of that, I am a professor, at Utah Valley University and bringing in my experience and and my work into the curriculum now, which has been so much fun, and it's going to be fun to see, like where, where some of this research is able to go, in the university setting as well.
00:02:42 T. Heath: Lots of exciting things. If I can, I'd like to jump in with this idea of attachment centered play therapy that you mentioned. I'd love to know. So something for me that I'm interested in is when people are doing new things, and often when we're doing new things, we're not doing like completely new things, but we're taking ideas and using them in new ways, or we're adapting them or combining them. And this is what I mean. And if we're not careful as therapists, I think sometimes we get stale. We just rinse and repeat. And so I'm really interested in your creation of something. So I'm wondering if you can say a little bit more about attachment centered play therapy, how it came to be. And also if you could talk a little bit about attachment and what you mean in this context, because that word gets thrown around a lot, and I find that people aren't always talking about exactly the same thing.
00:03:29 C. Mellenthin: Yeah, I think those are such good questions. So let me start from the back. The last question and then go to the first. So when we're talking about attachment theory and attachment science I think it's really important that we are holding spaces for the original theorists and the original theory, and with contemporary attachment science, which we have now. And this has been some of the coolest things that have come from our last, you know, decade especially. But the last two decades in neuroscience research is what we're finding from a very biological like neuroscientific viewpoint, is a lot of the original theory about attachment is actually real, like it's actually happening in our brains. And we are, you know, we throw this out there like we're wired for attachment. We literally are wired for connection and attachment. And it's not only parent child attachment. This is across the lifespan. Humans need humans. We need relationships in order for us to survive in this world. And so when we're thinking about this adaptation then to our clinical work. So we have like this theoretical foundation, in my work I kind of integrate Bowlby's original theory. You know, he later had a little predecessor of John Byng-Hall And I love the way that he's conceptualized attachment and talking about being secure enough instead of kind of having these rigid ideas of attachment patterns of how they were initially thought of, Byng- Hall loosen this a little bit and, and broaden some flexibility. And I love like I'm going to butcher this, but he, you know, he would say, like all of us are seeking to be secure enough. And for me as a human and as a mother and as a partner and, you know, it, it helps to take the pressure off of like, this thing that we're seeking for this optimal thing and bringing in that it you can be enough in it. You can be good enough in it. You can be secure enough knowing that like, we're never like one hundred percent secure in anything because we're in relationship with other humans. And, you know, and so kind of my adaptability is then bringing in Sue Johnson's work and others people's of looking at like attachment patterns as moving along a spectrum. So instead of these rigid categories, right, like I think sometimes when we were first taught about attachment theory, like in graduate school, you know, we're like, okay, Ainsworth had these four neat little boxes that humans fit into. And it's like, check, check, check. There's who you are. And none of us fit into neat little boxes and you can be in a really secure, healthy relationship and have the fight about the dishwasher that's never about the dishwasher. And then you move to a place of felt insecurity until repair happens, and then you move back to a place that felt security. And we have this ebb and flow dynamic across every relationship and every facet of our life if we're aware of it. Right. And and so when we're thinking about terms of a spectrum, I think we also get away from pathologizing humans and human behavior and human attachment seeking behaviors. And this is something that, you know, I really believe in wholeheartedly. Like we learn how to seek out our attachment needs based upon as adaptive to the environment and the relationships that we're in and what that gives permission for. And so, you know, when we're thinking about then applying this to humans, instead of like these neatly defined categories, you know, we're we're looking at this through a systemic lens, too, because you have the family system, whatever that constellation is, and you have a culture of how you do this, right. How do you seek out attunement and nurture and connection, and how do you not do this? And there's rules about this. But within that global constellation, each unique relationship has its own unique attachment patterns. And so this is where I think, when we can open it up to be like, this is a spectrum instead of something rigid. I think that we can help find our stories in it and find us in it and help our clients do the same. Because you're not failing at it if you don't fit into a neat little box, you're not destined to have these patterns forever. Which is this concept of earned security where we can heal. Like, none of us would do this work if we didn't believe healing can and does happen.
00:08:08 T. Heath: Yeah. For sure. One thing that I'm finding really interesting in what you're saying. Well, of course, the idea of because in like an intro to psych course, that's how these are. They're laid out in, you know, distinct categories. And then quite naturally, the students start going, well, which one am I right? Yes. And, you know, maybe that's an okay place to start from. But I worry sometimes that these do become almost like master narratives that then, you know, are self-fulfilling prophecies for people that dictate how they are in relationships. So I'm glad you mentioned that. You mentioned something else that's interesting to me, too, which is like talking about sort of attachment dance or pattern that's happening in a relationship. So rather than like sort of diagnosing a person, so to speak, with, with an attachment type or issue, it feels like what you're saying is you're looking at an attachment almost dance that's happening in a relationship. Is that right?
00:09:00 C. Mellenthin: Yeah, absolutely. And I love where that's where Sue Johnson's work has been so powerful and kind of framing contemporary attachment work to where we need to stop pathologizing humans as much as we do.
00:09:13 T. Heath: Now. Can you can you help me take this that you've just laid out? Which I get the sense, you know, you could probably talk about that for the entire podcast. There's a lot there, right?
00:09:23 C. Mellenthin: Oh, I can totally nerd out.
00:09:24 T Heath: Right, right.
00:09:26 T. Heath: And it is interesting. Part of what I want to understand is now how you take those ideas and you start moving them into play therapy.
00:09:35 C. Mellenthin: Yeah. So this definitely like, is not normal play therapy work. so in my work I tend to be very integrative and prescriptive. So meaning that for those who don't know, like when you're when we're practicing from an integrative or prescriptive model, we're pulling from different theories, different models to meet the client need in front of you. Like what does this individual client need in this individual moment at this individual point in time. Right? And so instead of having it like, okay, here's your ten sessions, this is all mapped out nicely and neatly for you. It's what is needed in this moment. And I think, you know, in order to practice from that perspective, like you also have to be flexible yourself and trained in more than one method and one theory model and one practice model, so that you have resources to pull from and tools to pull from, because you can be doing the same intervention with three different families and have it mean three completely different things. Right? And you can say the same thing to three different clients, and it's going to be interpreted three different ways. And so I think that being flexible and adaptable is a really key part of this. And so in attachment centered play therapy we're shifting our idea first of all, of who our client is. So instead of just an individual child the family system becomes your client. We're looking at this through a systemic lens because we can't treat a child in isolation of their system. And I think that this is where a lot of well-intentioned and historically well-intentioned, child therapists, especially, you know, as family therapy, kind of became out of vogue since, like, the seventies. And I think all of mental health began focusing much more on the individual. I think like the basic premises of systems theory. We all heard this again in graduate school, right? If one person changes, the whole system changes with them. But we can't expect the least powerful, most vulnerable person to be the change agent. That is such an unrealistic burden of responsibility to give to a young child. And they actually can't do anything to change their system. So if we want lasting change to happen, we have to be working with and including and involving the people who have the ability to create this, which is whoever is in that parental role and capacity in the life of that child. So that's like the first thing. And you look like you had something to jump in to say.
00:12:08 T Heath: You might be heading here.
00:12:10 T. Heath: but yeah, that like philosophically as you're talking, I go, oh gosh, this makes a ton of sense. And then in my head know I'm not a play therapist, although I've had the good fortune of talking to some play therapists and, you know, have a good friend who's a play therapist and that sort of thing. So I hear stories. And so now in my head, I'm imagining, okay, what you're saying that makes a lot of sense to me philosophically. I'm wondering how does this actually start to look in the room, you know, because so often at least my understanding of how play therapy is often done is the child is in the room with the therapist and I guess, you know, systemic themes or stories could be uncovered there, but I haven't heard much about, parents and families being an active part in the room. Now, I'm not saying that's not going on. I'm just saying this isn't what I've heard before. So I'm wondering if you can help us understand how this philosophy that you're describing with attachment and families, which makes a lot of sense, how that actually starts to look in the room and in practice.
00:13:13 C. Mellenthin: Right. So and what you're describing is so common, especially in play therapy, because child centered play therapy is one of the most well known and, prolific, play therapy models. And it is very much rooted in that individual child work. And I think a lot of child therapists are trained in this, traditional way of like you don't work with the parents, it's just with the child. And so when we're thinking about this in terms of attachment, though, it doesn't make sense. Right. Because we're not working with the system that could be making change. So even if you're doing parent consultations separately, you're not working within the relationship and you're not even seeing what's going to happen within the relationship and where healing needs to happen. And so that's actually like the second step of attachment centered play therapy is identifying where are there ruptures that need to be repaired. You know what is going on within the system that may be contributing to some of the presenting behavior referrals? Realistically kids are referred to us for behaviors, whether they are concerning or annoying to the adults around them. Like, that's why kids come to therapy. So when we get in this mode of, treating behaviors instead of the child and what's fueling behaviors, we're trying to solve like a thousand piece jigsaw puzzle with like seven pieces. And so my philosophy is that we invite the parents in right from the beginning. And, there may there are let's be honest, there are family systems where the parent may not be ready or the child may not be ready for that work to just dive in. And so sometimes we're being really flexible and adaptable while we're helping the parent to become a resource to their child. And so you may be working on parenting or some of the parent's unresolved trauma that's getting triggered in their relationship with the child. Or navigating the fallout when your child has had these great big, huge behavior outbursts, a lot of times a parent is fried by the time they come to therapy. Yeah. Like, it is not uncommon for me to have conversations with parents where they will say, I love this kid so much and I can't stand them. I don't like them. I don't like who I become with them. And I, I have done everything I know how to do and I don't know what to do anymore. And they're so defeated. But if you're in this place where you don't like your child, or you're afraid of them, or you feel like you've lost all control and you're in this place of helplessness or crisis yourself that parent is calling out for help. And I think really well intentioned child therapists, oh, thank you so much for letting me know. And then they never acknowledge or address it again because they're focused on working with the individual child instead of what's happening within the relationship and into the system that the child is engaged in. And so I am a big proponent, like, I don't ever make a child come into therapy by themselves unless they want to. And I let parents know this, right from the beginning, the parent consultation. Like every session, I'm a firm believer in giving kids areas where they feel like they can be in control because so much of their world they have no control over. And so I prep parents that I ask them, I'm like, your kid gets to choose if you come in or not has nothing to do with you. Because some days they're going to want you. Some days they're not going to want you. And with some of our little anxious ones, like when they know that their grown up can come in with them, you just see them, melt with relief, right? I mean, because child therapy is also this weird place, we teach kids all the time, don't go anywhere with strangers, don't go behind closed doors with strangers. Definitely don't take treats from strangers. And then you're like, hi, I'm your play therapist, so come behind a closed door and come get a treat with me. And we have no relationship of trust built. I think giving a sense of control in healthy ways is also so important.
00:17:24 T. Heath: I'm hearing how you're describing this and I'm intrigued in multiple different ways. One is that the child's given the control there or the child can sort of decide, do they want to come in on their own? Do they want the parents to come in? And it sounds like that can vary like one session. It could be with a parent or parents or family and another session it could just be with the kid. But they have control over that, which I think is really interesting. Now, I could take you a step further and say, okay, when when parents maybe. Is it maybe it's not just parents because it's attachment centered play therapy. Maybe it involves siblings sometimes. I don't know, you can comment on that as well, but but let's just think about parents for a moment. When parents come into the room and you're doing play therapy, are parents an active part of the play? How do you help facilitate that?
00:18:18 C. Mellenthin: Yep. So my role for parents is they are active. If they're in the playroom, they're actively engaged in the play with us. Unless their child tells them to go sit over in the corner and then they can sit and observe if that's what their child needs. But one of my one of the reasons behind giving a child a sense of control is a lot of time. A lot of the externalizing behaviors that that bring a child into therapy, where they are so out of control they're searching for being in control. And so if we can start giving them these healthy doses of consent, of control that are appropriate for their age, but That also helped them not feel so powerless and helpless within this adult world, right? And so part of play therapy is like, instead of having this child come up to my adult functioning like we're going to sit down and have some good old traditional talk therapy, right? I don't know if you've ever tried to have a sit down conversation with a five year old, but, you know, the attention span doesn't really last that long. And so what we're doing is we're coming down to their world and how a child makes sense of their world and experiences their world and makes meaning of their world is through play. So this is actually the child's natural first language is play. And kids learn how to play and they play before they speak. And so what we're also doing is inviting the parent to join us, to look at the world through their child's eyes and play gives us a window into the child's universe. And so some parents, they need a lot of coaching before they're in a spot where they can do that. Other parents can jump in and they are just in it, and they can join their kids play as much more comfortable for them. And a lot of times those parents had parents who played with them.
00:20:15 T. Heath: See, this is really interesting because I've heard stories in speaking with other play therapists where, you know, there's there's even parents who who'll be like, oh, I don't play, or they're so detached from play that they don't even know their kid plays. You know what I mean? They're like, oh, my kid doesn't really play. And so I'm, I'm glad that you mentioned what you mentioned there, which is that, you know, some parents have it sounds like a strange thing to say. It's like it's like Peter Pan or something, you know, but but the Lost Boys, but like, some parents have to learn how to play. Presumably they played at some point in their life, but they have to learn how to play again and not only play, but also play within the confines of their child's world. And I imagine that could sometimes. So you could have some parents that like, think they don't know how to play. I bet they do somewhere in there, but they feel like they don't know how to play. You could also have parents, I'm thinking, who might come in and sort of dominate the play, which would be interesting. And so it almost sounds like you're having to kind of train the parents of how to play with the child. Am I getting that right?
00:21:15 C. Mellenthin: Absolutely. And teaching them how to be with their child where it's not like, here's an activity that we're going to do, but sitting in that vulnerability of being present and being with your child, it is vulnerable like that in and of itself is vulnerable, which can trigger the parents attachment patterns themselves because we try to defend against vulnerability. And and some parents, I mean, you know, you and I both work with adults, and most of the adults that I work with have pretty significant unresolved childhood trauma. So it's a really beautiful place to be because I'm like, we can do this work together in this space that that little part needs. But, I, I have worked with adults who are never given permission to play.
00:22:02 T. Heath: Yep.
00:22:03 C. Mellenthin: And, you know, like one of my clients, at five, his job was to make dinner for the family. It was a lot of hot dogs and mac and cheese. But he had these adult responsibilities. He had to make dinner for his little brothers and sisters at five. And he had to figure out how to make this at five because nobody was there. He became the caregiver.
00:22:27 T. Heath: Right.
00:22:28 C. Mellenthin: You know, and another colleague shared with me a story where she, was doing some more directive attachment work, playing with a mother and child. And at the end of the session, the mom just starts sobbing and she's like, whoa, like, help me understand what's going on. And she's like, I never knew a mom could do this.
00:22:46 T. Heath: Mhm.
00:22:47 C. Mellenthin: This idea of play being vulnerable, not only are we socialized outside of playing as we get older, right? Like if we saw, like, a fifty five year old man having a tea party with stuffed animals, we'd be like, whoa, you're a little weird over here. Yeah. If that same man was having a tea party with his granddaughters and stuffed animals, we'd be like, oh my gosh, you're the cutest human being on this planet. Right. But we're socialized out of play. But play is also a key attachment need that we don't talk enough about across the spectrum. And if that was an attachment need that was never really fully met for you in the way that you needed it, you may not understand how to give it or that you even should be. And I think that this is why it's so important that we're working with the parent in conjunction and collaboration with their child. Because if we're only doing child centered work and only seeing the individual child, you never get any of that information and they never get the experience of how healing it can be.
00:23:52 T. Heath: Mhm. Yes. And now I'm wondering, you know I again not as a play therapist just things I've been learning and hearing. I mean I did one play therapy practicum in my PhD program so I have limited limited knowledge. So I'm no expert. But there seems to be some folks who favor, like, a more non-directive approach where the kid comes in and sort of takes over, and just plays and literally directs the session. I mean, sometimes there have to be some boundaries put in place, of course, for safety or whatever. But generally speaking, the kid runs the show and then, there are approaches that are more directive. And I'm wondering, how does this look in attachment centered play therapy in in your work?
00:24:34 C. Mellenthin: So it depends again it's being that prescriptive place like what does this? What are the attachment needs of this particular family in this particular relationship? And how can I best help them with this? Right. And so a lot of this is dependent upon what is needed. And I think that that's where it's having a broad foundation in different theory bases is important because some kids need a much more structured. And adults, let's be honest, sometimes the adults need a much more structured place where there's like a plan. And, I think sometimes, especially when your world has been full of crisis and chaos, you may need a plan of like, this is what we're going to do and how we're going to do this, being flexible and adaptable, within that. But there's a plan. For others, they need to experience the messiness and the chaos and giving up that power and control and trusting the inherent wisdom of that. A child actually knows what they need to heal. And so being part of that, that's when you become that resource. And so part of what we're doing is we're teaching the parent these skills of what we're doing as therapy, how to be present, how to track and create a coherent story within the play, understanding the meaning of symbolism and metaphor. And and explaining like maybe, you know, some of the things and themes that you're noticing in the play, not necessarily while the child is there. That would be a parent session that you'd be having, but helping the parent understand why we're doing what we're doing. They should have an understanding of this so that they can be a more effective partner and part of the healing journey.
00:26:23 T. Heath: I found in speaking with play therapists that sometimes the process can take a while. It has to unfold. And, of course it can in more traditional forms of talk therapy as well. But we're in a world, um, of managed care. We're in a world where you got to get stuff done quick. I mean, not necessarily. We find ways like, I don't operate that way. I find ways to subvert that system, of course. But the dominant systems, I think many people are told, you know, you only get X number of sessions and you got to move quickly. And what I've heard from really skilled therapists is that sometimes this takes time. Wondering if you can speak to the element of time and how how that flows through attachment centered play therapy?
00:27:05 C. Mellenthin: Yes. So this is where I truly believe that each of us are a conduit in somebody's healing. So I oftentimes use the metaphor of like a lily pad, like our job is to be a lily pad, and that is us representing safety and security. We're a safe based, secure heaven haven. Um, and so, like our little froggy, like our little client comes and lands on the lily pad to rest, repair, rejuvenate, replenish. So in the next season of healing, they can make a leap to somebody else. Like, no matter how long we work with the client, we're never going to wrap them up with a neat little bow and be like, Tada! You're healed. You never have to look at this again. I think when we can remember that, like, sometimes our most important therapeutic work is just being with and showing up in our own authentic selves, but being with the client in the ways that they need us. And so, you know, for clinicians where they're like, I got six to eight sessions, like, okay, you have six to eight sessions. So ethically, you probably need to be doing a more solution focused approach on the here and now. And what can we build right now since we have six sessions together. That's being a lily pad. For somebody else where they're doing longer, more in-depth work. And they may have the luxury of twenty five sessions, which is about the number empirical, you know, evidence is showing about twenty, you know, around twenty five sessions. And when we start seeing major change happen in the child centered approach, but traditionally in therapy, with with kids, when doing play therapy, that's like a rough estimate but a pretty good ballpark. And a lot of therapists don't have the luxury of having six months to a year to three years to be working with a family system, but you can still do so much good in the time that you have. If you're practicing within that scope of competency and being mindful of what are my limitations here. I get this question a lot when I'm training school counselors on this type of work. They're like, what can I do? I don't work with the parents. I'm like, no, you don't. Who are the other safe grownups in this child's system that you're working with, though? Where we can start maximizing some safety and security. How can you be a lily pad and hold space for this child in the spaces that they're at? Because part of what a child needs is to feel fully accepted for as they are, where they are, for who they are. And that is a quote I love from Gary Landreth, because he says, a child will change when they feel like they don't have to change, which is such an interesting way of framing this. But in terms of like our clinical work, it means when a child truly feels loved, when a child truly feels accepted and acceptable with all of their messiness and good, bad, ugly, beautiful parts. When they know that, when they experience it, when they have that felt sense of safety and security with you and between you and within the relationship. That's when change happens.
00:30:14 T. Heath: So that's a really great quote, by the way. Yeah, I think I think that often holds true with adults as well. And couples when I work with couples, it's there's a lot of wisdom in that. And, I hear you citing the research, you know, on average twenty five sessions. And so my, my sense would be in a perfect world, and it's often an imperfect world, but in a perfect world, are you saying that, you'd like to have as many sessions as you might need?
00:30:41 C. Mellenthin: And I think that, that would be ideal, wouldn't it? Yeah. Like if our patients could just get the work that they needed without any other constraints. So ideally, yes. And knowing that we don't work in ideal systems.
00:30:54 T. Heath: Right.
00:30:55 C. Mellenthin: You do the best you can with the time that you have. I think for therapists, it's remembering that we need to model what secure attachment looks like and feels like to our clients and to their systems, right? And so, not being afraid of working with parents like so many kid therapists are like, oh, give me the kids. I love the teenagers. Their parents. Oh, no thank you. We can't be afraid of the grown ups like you're a grown up. You're a grown up, too.
00:31:25 T. Heath: I want to tap in your expertise a little bit there. Because you've been doing this a lot of years. I'm wondering, because I hear that all the time from therapists all the time. Oh, I don't mind working with kids. It's the parents I don't want to work with, you know? And it's almost become like a cliche at this point that just gets regurgitated sometimes without even people thinking. What do you think that's about? What like because with any sort of cliche or something that's recited over and over, when we're not even really thinking about it, there tends to be some truths that underlie it. And so what what's your understanding of what that's about? Why don't people want to work with parents?
00:31:58 C. Mellenthin: So can I nerd out with you for a minute, please?
00:32:01 T. Heath: Nerd. All the way out.
00:32:02 C. Mellenthin: So my dissertation research for my doctorate was on registered play therapists. How their attachment histories show up and influence their work with children and families.
00:32:14 T. Heath: Oh, interesting.
00:32:14 C. Mellenthin: And yeah, it was. It's so cool. And it was like the first the first research that's been done specific to play therapy looking at this. But honestly, I think a lot of it stems from our own attachment stuff. So, if we grew up with authority figures who were scary or mean or invalidating or, all the stuff, like we expect other grown ups to be that. And, if our own little internal working model of self going back to Bowlby's work, if you were raised in a home where you did not experience consistent and predictable nurture. Attunement. Caregiving. Safety. Right? Your internal working model of self may have been developed into "I may not be worthy of love and belonging." And we set up our expectations for relationships based upon our own sense of worth and inherent dignity. And I think a lot of times, working with parents, our stuff gets activated and we may unconsciously be playing out our own stuff with these parents. And coupled with that, we do a horrible job of training newbie therapists and our graduate students and how to do this complex, vulnerable work. I mean, like, I'm, I'm a professor right now and being on this side of things at the university, by the way, this is new for me. So I'm like, oh, talk about systems and complex, ridiculous systems. In our courses, like we've lumped family therapy and group therapy together or they get like the fire hose of here's every theory and every practice model. And it's kind of like going Baskin Robbins. And you're getting like a sample scoop of every kind of flavor of ice cream. Yeah. Yeah. I mean, that's kind of like how my graduate work was like, you know, and it's like, oh, when you're out in the world, then you get to define this. But if you never got more than a sample taste, you may not understand the complexity and the nuances of how good this could be, right? I remember when we started having gourmet ice cream, for example, and I was like, you're putting honeycomb and lavender together. Like, those flavors do not make sense in my brain. And so the first time I tasted it, I was like, oh, this is kind of funky. I'm not sure how I like this. You need more than one taste. You need more than one experience to develop a palate. And I think our clinical work is so similar to that. But we do a terrible job of training therapists. You don't have to be trained in how to work with family systems in any discipline, even in marriage and family therapy, which is bonkers to me, let alone how to work with children in the family system. And and so I think when we haven't. And it's not to like shame other therapists. That's not what I'm talking about. But it's building that awareness. Like the whole person of the therapist. Right. With Aponte's work of understanding our own story and how this is playing out within the therapeutic relationship is a really important part of the process of healing for both people. And I think when you tend to shy away from conflict or pull back from vulnerability, like this is kind of like your natural defense mechanisms. You're going to do the same thing in therapy.
00:35:39 T. Heath: I'm wondering and by the way, it's totally safe to say no or I can't think of any. Totally cool. But but in a general sense I'm wondering if you can identify like a family that you've worked with in play therapy and share just a little bit in a general sense of how how it worked, maybe even in way that surprised you and and how that might be a little different than how it might have looked in other forms of play therapy. And I say different. I'm not, you know, we don't have to judge this as good or better or whatever, but you're offering something that's a different approach. And I'm wondering if you can highlight maybe an example or two of how that's actually worked differently. So people can can make sense of that.
00:36:25 C. Mellenthin: Yeah, so there's I live in just I practice in Salt Lake City, and there is the primary children's hospital. And one of the pediatricians there loves to send me their really complex cases, where there's a lot of medical trauma and they usually come in waves. So this last fall, I had a wave of kids, and referrals from one of the pediatricians up at the hospital, which all of them shared in their diagnosis, where their GI systems and their digestive tracts just do not work effectively on their own for one reason or another.
00:37:02 T. Heath: Um.
00:37:03 C. Mellenthin: All of them have had chronic, consistent medical trauma happening with really invasive procedures, literally to keep them alive. And not only is the child traumatized, but the parent is traumatized. And what tends to happen, especially with chronic medical conditions, in order to stay out of the hospital. The parents are trained how to do some of these services at home, where they have to step into that role of like a health care provider.
00:37:30 T. Heath: Mhm.
00:37:31 C. Mellenthin: And the result is you can have really traumatized family systems with all the best intent in the world of we're trying to keep this kid alive. Right. Like it's nobody's fault. And a lot of times with trauma honestly it's nobody's fault. It is just part of our human experience, unfortunately. And so working with one of my littles, she has been in and out of the hospital her whole life. Her bowels just do not eliminate on their own. And so she's had to have lots of invasive procedures, lots of medication, like the amount of medication this little one has to take every single day to just effectively eliminate her bowels is heartbreaking. And part of the treatment was the mother, had to give her a nightly enema. And this is to keep her out of the hospital, right? Like it has to happen, or else she's going to develop sepsis and lots of other horrible things can happen. And so with her giving her a lot of options of control from the beginning is so important because she's had absolutely no control whatsoever.
00:38:43 T. Heath: Um.
00:38:44 C. Mellenthin: And you know, I'm sure this is not surprising to a lot of people, but she really gravitated towards a lot of the medical play. So she's playing out and trying to make sense of these experiences. But she got to be the doctor instead of the patient. So for many sessions, I was the patient and she would bring me to the brink of death, and kind of using some of the medical jargon of like, I think we're going to lose her. I'm not hearing her pulse like she's talking about and playing these things out that she had experienced. And then she invited mom to come in, and mom did such a great job of being the patient, and she started using the language that was used between them and the words that they were calling the different medical devices. She's like, oh no, Claire, we're going to lose her. I think we have to use the tube. I'm like, oh no, I think we're going to have to use the tube. What are we going to do? She's like, I don't know. This is this is tough. It's a touch and go thing. I mean she's like literally playing out what she experienced on the table. Wow. And her mom did such a good job of fully being present with her in the play, letting her play out these medical things and these themes with her. And this is called abreaction, right? It this gradual re-enactment of play. But through this, she's gaining mastery over her story and also making sense of her story and being able to not be a victim in it. Right. And so she would play out this life and death over and over and over and over and over, sometimes with me, sometimes with mom, sometimes with dad, sometimes with both of them. Right. And they did such a good job of just being what she needed them to be in that moment with her.
00:40:37 T. Heath: The this might be this might be such an easy question to answer, but I just want to ask it why is it important that the parent like. Like what if you had been in there and you were in the role that mom was in? Is there particular significance that mom was in that role or parents were in that role? And I'm wondering if you can speak to that a little.
00:40:58 C. Mellenthin: Yes. So I'm a surrogate attachment figure as her therapist. Her parents were with her through the trauma. Her parents were with her during the trauma and were part of the traumatizing experience. But what happens, especially with trauma, is kids develop these beliefs about the world, these trauma beliefs, and it's rooted deeply into attachment. So when trauma occurs, my parents either can't protect me, but we're in the state of helplessness together or chose not to protect me. And if a child believes and they get this belief that my parents chose not to protect me, that is going to impact that relationship forever. And when the parents like in this case, the parents were part of the trauma experience and they while they were being simultaneously traumatized by it. Right. But her being able to be empowered over her parent when all of those years where she her parents were in power over her. She needed that empowerment and that experience of like being omnipotent almost, you know, where she could reenact the trauma but have control over it instead of being helpless in it. And I truly believe if her parents had not been able to be part of that, we would still be in the mud together, so to speak. I've worked with her for almost a year now, and the last couple sessions her play has completely shifted away from this. She is. Her mood is happier. She's not as explosive at home, so her temper tantrums are decreasing. She's able to roll with life so much easier. You're seeing like, this ripple effect of healing happening across systems. And her parents are simultaneously doing their own work too, they're so good and so invested in in this process, which again, kind of unicorn clients sometimes to have that. But we're just are tapering off right now to every other week therapy where before sometimes it was twice a week. And she's moving into a place where mood and affect are congruent. She is handling stresses like she just started pelvic floor physical therapy. Again, this such this little teeny body has to have so much work happen to it.
00:43:21 T. Heath: Gosh.
00:43:22 C. Mellenthin: And both all of us adults were planning on after the assessment because that's a pretty invasive assessment to do pelvic floor physical therapy.
00:43:31 T. Heath: Yes.
00:43:31 C. Mellenthin: And she just moved right through it. We were like, I was in shock over this. I was totally expecting. And the parents were kind of accepting of like, we're going to need to do some like, you know.
00:43:42 T. Heath: Yeah.
00:43:43 C. Mellenthin: Let's get her in. And we're we're bracing ourselves knowing it's going to be a rough night. And she's like, great. Totally rolled with it. And I think it's because that foundation of safety has been reestablished. This is why we involve parents in the process, whenever it's possible. However, it's possible. And us being flexible and adaptable. I meet with the parents every month at a minimum without their child present as well, so that we can be working on the attachment stuff. What's coming up for them as an adult? Because parenting is so hard, even on the best of days. Like we don't talk about how hard this really is, and then you throw in this burden and this lifelong experience of trauma together, and it's really, really hard and incredibly painful. So, yeah, to be working with that component of grief, too.
00:44:37 T. Heath: Yeah. I mean, I have a thirteen year old and a nine year old, so I felt that in my bones. When you said parenting is really hard and we.
00:44:44 T. Heath: Don't even.
00:44:44 T. Heath: Without all the extra trauma, it's really hard. And it often asks things of us that, that we don't have good answers for all the time. Right. And something I am intrigued by that you're describing is that the parents are an active part of the process. It feels like, this this is, you know, the child has the control and the power and the child decides. So the child's at the center, which is cool. And also it feels like the healing effects move through the system. And so the child is still like when, when I was first hearing about this, um, I don't know, last time we talked, maybe a month or two ago, you know, and I hadn't read much about it. I read more in preparation for our conversation today, but I was thinking like, okay, But then like does is if it's about the system, do we lose something in that? The child's not in the center. Because often in play therapy, I mean, that's part of the idea is that this is the child's time and place, and there's something special about that. But as I've read more and I'm listening to you today, even more so, it's like, no, the child still is at the center of this, and they still do have the control. It's just that the healing sort of involves the entire system, and the whole system can be. It sounds like, hey, if the child was like, I don't want my parents in at all. Okay, well, like you said, you're adaptable. You're flexible. You know, then they may not come in the room, maybe they do later on or whatever, but not when the child doesn't want them in there. But it still seems to me that it's systemic, but the child's still centered, if that makes sense.
00:46:19 C. Mellenthin: That's actually why I called it attachment centered.
00:46:22 T. Heath: Um.
00:46:24 C. Mellenthin: Because I think that that visualization of like, again, that lily pad of like, we are holding this little one and they are the center of it. Absolutely.
00:46:36 T. Heath: Okay, so I'm imagining people listening to this, and I'm imagining, current play therapists, out there that might be listening to this. And if they were intrigued and they're like, okay, I'm wondering about involving parents in, in the work that I'm doing with kids in this way. Where would you tell them to start?
00:47:00 C. Mellenthin: So it's so cliche when I'm like, oh, read my book, I think that it is actually starting. Be brave. Invite the parent to come into the playroom with you. Show them what you're doing and why you're doing it. And we nudge our little clients, like, you know, I love our time together too. And sometimes we have to teach our parents how to be the parent you need them to be. So we need to bring them in here so we can teach them. What do you think about that? And I think when we frame it that way, it also helps lower the defense mechanisms of the child because we're still on the same team. You still get to be the boss in here. And we kind of need to let this guy over here come in so we can teach him how to be a better dad. Like the kind of dad that you need him to be right now. And and most kids are like, oh, we get to teach them. I'm like, yeah, we're going to teach them. They're like, sweet. I'm all over that one, right? And part of this is your assessment too, of like, is it appropriate at this point in time to bring the parent in? But if you haven't been working on building a relationship and a therapeutic alliance with the parent just as much as the child, you may be missing really important pieces of the picture.
00:48:20 T. Heath: I get that it can be a little uncomfortable to like, talk about our own books and stuff, but you mentioned your book. You might. I mean, do you mind saying a little bit about it? I imagine people might be interested after hearing this.
00:48:32 C. Mellenthin: Yeah, absolutely. So yeah. So Attachment Centered Play Therapy. There is a book on this and, I'm actually working on the second edition. My editor just sent me a reminder of like, hey, I need this from you. but it walks you through how to conceptualize this, how to develop a treatment plan, how to look at your own stuff. And each of the chapters in, like the later parts of the book, is looking at the different attachment ruptures that can happen. So and then how do we work within the system to heal this. And so, divorce, death, grief and loss, deportation, incarceration, immigration, all these big things that seriously impact family systems and kind of pull them to the threads, let alone the everyday bumps and bruises of life that can happen in relationships. But each of the chapter walks you through how to assess for this, how to look at this through a systemic lens, and then how to work within the system to create repair and healing. And, I'm constantly out there somewhere training on this or topics similar to it. And all my events are on my website. It's clairmellenthin dot-com and Instagram is where I post a lot of my stuff, and that's clairmellenthinplaytherapy
00:49:51 T. Heath: Fantastic. I'm going to ask you one last question. I often ask this of guests, but I think where you're just starting now in the university, I think you might have some really interesting ideas. I think sometimes, even with the best of intentions, I don't think this is done purposefully. Formalized training becomes stale. Yes, we we often are. I don't know, sometimes it feels like decades behind, just to be honest. And what what we're teaching students isn't always indicative of what's actually happening out in the world, you know? And then sometimes you have people teaching that haven't, you know, practiced for twenty years or whatever it is. There's all sorts of reasons why this happens, but imagine that you're put in charge of and maybe you're already doing this teaching play therapy for a program. And also you can do it however you want to. Like, you don't have to do it the way it was done for you. It's your canvas. I mean, how how would you teach it in ways that maybe differ than some of the standard practices and teaches you came up with?
00:50:53 C. Mellenthin: So it's experiential. First of all, so instead of being boring, we're actually learning through play, but I'm bringing in this perspective. Um, instead of that singular, like traditional child therapy lens where you only work with the child and this is what we do. I think that that's such an important foundation to have. So if you don't have any training in Non-directive work, it's so important. I mean, learning how it's a skill, learning how to show up and be absolutely present with another human, especially a little one. Like when you're engaged in that type of work. It's-- One, it's exhausting, but you're not thinking about your laundry list of things you need to do. You're not thinking about your notes you have to write or the report you have to make. Because if you step out of that presence with the child, they understand it, they see it, they feel it. They will call you out on it. I think that foundational training is so important. But I think also coupled with that is looking at life through a more multifaceted lens. Because we're humans, none of us are going to fit into a neat little box ever. And so we need to broaden, the way that we're framing this work that we do as clinicians and opening it up instead of becoming more entrenched and constricted in it.
00:52:14 T. Heath: Sorry I lied. One more question.
00:52:16 T. Heath: How are how.
00:52:17 T. Heath: Are you enjoying teaching? How's this coming along early on?
00:52:20 C. Mellenthin: Oh, honestly, I am loving it. I I've missed being in the classroom. Being with the students. I love it. I absolutely, just wholeheartedly love it. Some of the behind the scenes systems that I'm still trying to, figure out and navigate where I'm like, why do you guys make this so hard? Like, why are all these bureaucratic systems in place? I'm sure there's a good reason. But, you know, navigating that part has been like a fire hose of orientation, seeing the behind the scenes. But I love working with students. I love teaching students.
00:52:54 T. Heath: Um.
00:52:55 T. Heath: That's fantastic. And you're right. As a chair of a department, I can tell you I ask that question about systems all the time. There's systems on top of systems on top of systems. And what are what are we doing?
00:53:06 T. Heath: And and.
00:53:08 T. Heath: Also.
00:53:09 T. Heath: Even. Right, right.
00:53:11 T. Heath: Even despite these systems, we can still find ways to do meaningful and important work. And it very much sounds like that's what you're doing, not only in academia, but, you know, out in the world at large. It's it's really been a pleasure. I've loved learning about these ideas that are new to me. I've taken a lot of notes, uh, just for myself. And so I know I've learned a lot. I'm sure our listeners have as well. Clair, I really appreciate your time. Thank you.
00:53:36 C. Mellenthin: Thanks so much for having me.
