More than just fun and games

Dr. Suzi Kagan, of Association for Play Therapy-Israel, speaks about value of play therapy in diagnosing, treating emotional trauma in young children.

Dr. Suzi Kagan (photo credit: JUDY SIEGEL-ITZKOVICH)
Dr. Suzi Kagan
If children are too young to speak, it doesn’t mean that they haven’t experienced painful and even traumatic events and that their hearts and souls don’t ache. Play therapy provided by a professional can not only diagnose such unspoken emotional anguish but can also alleviate and even cure it.
Dr. Suzi Kagan, the founder and president of the Association for Play Therapy-Israel and professional counseling consultant to the popular Channel 2 program Super Nanny, believes that toddlers as young as two and children up to the age of 10 who can’t verbalize their feelings easily or at all can greatly be helped with play therapy.
Born and raised in Eilat to parents of Moroccan and Azerbaijani origin, Kagan served in the IDF as a dental assistant and then studied physics, biology and chemistry at the Hebrew University of Jerusalem’s agriculture faculty in Rehovot. Then she and her husband, a computer expert, went to Texas for his work with an Israeli company and remained there for a decade. She used the opportunity to earn her master’s degree in school counselling from Dallas Baptist University and her doctorate in counselling and higher education at the University of North Texas in Dallas, where she learned play therapy. They returned to Israel in 2005 with their two sons and one daughter, now aged 15 to 10, and also recently became foster parents to a two-year-old girl.
But when they resettled here, they found that the move had caused a crisis in their children.
“I try to separate my kids from my work, but I decided to use toys to help them. None of them knew Hebrew when we came back to Israel, as one of our sons was mistakenly diagnosed as being mute; we were advised to use only one language so he would not be confused, so after sign language, we went to English,” she recalls in an interview with The Jerusalem Post.
But then at one Shabbat dinner, when the silent toddler was two-and-a-half years old, he suddenly started to speak.
“He said: ‘Pass the salt.’ I supposed he hadn’t needed salt before,” Kagan recalls with amusement. “There had been an error in diagnosis, and as I didn’t know how to diagnose language problems, I couldn’t disprove it. Since that Shabbat dinner, he hasn’t stopped talking. He is now 10 and completely normal.”
A parent, she continues, “can help if he’s a professional. But if there is no improvement, it is best to go for consultation. Now all the kids are doing very well and feel completely at home in Israel, they are even regarded as gifted.”
During the first three years of life, the right hemisphere of the brain is dominant; sensory information from the left side of the body crosses over to the right side of the brain, and the right hemisphere is the primary domain of play, symbol and metaphor. The left hemisphere, which is the primary center for logic, language and linear thinking, doesn’t come online until a year and a half, when children speak their first words. When no verbal memory is present, toddlers express their experience of trauma through behavioral memories in the right brain. This is why play therapy can be effective at a young age when the left brain is only developing.
When Kagan learned of play therapy, she was enchanted by it.
“Virginia Axline, a student of psychologist Carl Rogers, initiated it as a theoretician. She regarded the troubled child not as the problem but as the center. She developed child-centered play therapy.”
When the Kagans returned to Israel, she found that although the therapy was hugely popular in the US, it was not recognized by the Health Ministry as a profession here, even though government offices use it.
“I found that only clinical psychologists did it; they took a box of toys, gave it to a child did a dramatization. It was not the focus of therapy but regarded as just another tool.”
Kagan decided to develop the field here for a wide range of difficulties and stress sources faced by young children, including the birth of a sibling, parental divorce, being in a road accident, and abuse – from the normative to the pathological.
“I went from being a big name in play therapy in the US to being a no-name here. I went to Bar-Ilan University’s School of Social Work, but they said they had never heard of it. But they said that if 10 students registered, they would agree to open a course.”
Today, there are 100 students, most of them women, as psychology is increasingly a woman’s profession – a year. There is even a waiting list, said Kagan, who teaches at BIU’s School of Continuing Education, works with her non-profit organization and has a private practice. The students include social workers, clinical psychologists, doctors, nurses and others who work in public or voluntary institutions or privately. Now the play therapy association, which gives accreditation to students who earn a certificate after two years of study, has some 100 members.
Toddlers as young as two and even speaking children as old as 10 find it difficult to verbalize emotions. Even teens and adults with bottled-up emotions can benefit from the techniques, Kagan notes. She and BIU have established a play therapy clinic at the Jerusalem Haredi College in the city’s Malha quarter for diagnosing and treating children from ultra-Orthodox families. Kagan established a clinic in central Tel Aviv for refugees from Darfur.
Her association also initiated a pilot program for prisoners who are in for life.
“There is a very bad connection between such people and their children. They don’t know how to speak to their kids even on the phone. Visits in the institutions are even more difficult. But the kids are entitled to know they have fathers and build a relationship with them. Women in prison already receive a lot of help with this, but not the men.”
She and her voluntary organization were allowed to work with the most difficult cases – sex offenders and murderers. Because prison rules prevent taking children there to play together with the fathers, she had to work solely with the prisoners.
“It’s a security problem,” she says. She and six of her BIU students went to each prison and held sessions with 50 to 100 prisoners, including Arabs who were not there for security offenses.
“We weren’t allowed even to bring films. We couldn’t bring plastic toy pistols or handcuffs to act out; it’s against regulations. We worked with balls, dinosaurs, markers and drawing boards.”
After six weeks, Kagan found that fatherchild relationships began to change.
“We saw that communication on the phone was better. They expressed their love and learned to call and say goodnight. Even though they had committed horrible crimes and got a life sentence, they love their kids. Those who go on leave on good behavior especially benefited. The children could finally be be proud of having a father too.”
Among the many cases she has treated over the years, Kagan recalls the case of a two-and-a-half-year-old girl who demonstrated sexual behavior not suited to her age.
“It was unusual, as her parents were good-looking, intelligent and well off. I engaged her in play therapy. It turned out that the father had raped the girl.”
Although Kagan testifies in court about her diagnoses of abused children, she much prefers to use the technique for treatment.
“It is short-term therapy, and it works. Kids don’t have to speak, only play and act out. I quickly see positive results.”
She notes that Israel has a high rate of selective mutism – that for psychological rather than physiological reasons, a child refuses to speak in some environments while talking in others. Play therapy, Kagan says, can be very effective in resolving their problems.
Although there are claims of false memories in older children and adults, Kagan said that play therapy indicating abuse doesn’t necessarily mean a young child has been abused.
“We do check to find out whether they observed disturbing behavior on TV or on the computer, though. There are children who are traumatized by what they see on TV. There was an 11-year-old who saw on YouTube a video of Jellyman who kills Spiderman and was very upset. Seeing Disney’s movie Bambi with the baby deer’s mother dying in a fire can be traumatic to children,” she says.
Kagan said she is not sorry that she did not study to be a clinical psychologist.
“If I had, I would be focused on a problem and not on the whole child. This shortens the treatment. It allows the child to grow,” she says. Treatment is for a number of months, up to a maximum of a year. “It never drags on beyond a year,” she adds.
Play therapy is not needed for every troubled child, Kagan continues.
“If a child was brought in because he was angry, wild and threatening to hit another child, I usually find he doesn’t need such therapy. It is only a certain matter that upset him, for example, that the other child called him a name. One can give advice to the kindergarten teacher, to the parent or to the child himself and solve it.”
The typical clinic therapy room has walls covered with shelves that have a wide variety of toys. Each shelf is for a different category – art, nurturing, aggression therapy and so on. The child enters and chooses the toy. Books are not included. Kagan never makes any suggestions about what to choose. Children angry over their parents’ divorce usually choose dolls to act out. Sometimes she uses sand tray or sandbox therapy. Abroad, The Sims computer games are used to construct virtual worlds, but Kagan has not yet tried working with this.
Her association has set a minimum price of NIS 180 per hour for play therapy, but this does not include low-income populations who get major discounts. In private clinics in well-off neighborhoods, the per-hour fee by therapists can reach NIS 400.
“There is a minimum price, but no maximum price. We supply services to government ministries and institutions,” she says.
In another decade, she expects there will be many more play therapy specialists.
“We will understand the world of children better. We will know how to pay more attention to them. And I am sure that by then there will be recognition by the various authorities that play therapy can really be effective.”
Those interested in learning more about play therapy in Israel can contact Dr. Kagan at [email protected].