Ep 25: Healing Through Play: Exploring Medical Play Therapy with Sarah Erdman
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This is a rough transcript created with Artificial Intelligence technology. Any misspellings and sentence errors are a result of imperfect Al.
sarah Erdman is the director of children and family services. And she's an associate professional counselor. Who's earned her master's degree in clinical mental health counseling from the university of Georgia. She's experienced working with children, adolescents, families, and adults, providing trauma focused therapy.
Sarah has trained in art, in play therapy, medical play therapy and trauma focused cognitive behavioral therapy. And has a background in working with survivors of medical based trauma, sexual child abuse. Physical abuse and witnessing. Domestic violence and suicide. She has a passion for working with those who have experienced trauma desire, creative interventions, and therapy.
And who have chronic medical conditions.
This is awesome, Sarah. Can you tell me, can we start right off the bat about medical play therapy?
I've actually haven't heard, is that a specific training or is that like your two, your things combined? So honestly I love thinking about medical play therapy. So it actually originated in child life. Um, so my background before I entered the mental health sphere, I was in education and I was teaching in the states and I taught abroad, um, in Northern Italy.
and I kind of knew I wanted to gravitate out of the educational field and into mental health, but at first I thought about child life, so pretty much kind of that support person in a hospital. And part of some of my beginning of child life training was a medical play therapy course. Wow. Which I thought was really neat.
And then as I. Transitioned and shifted to truly clinical mental health. I didn't understand why it wasn't addressed, especially when we talk about children child development trauma, I'm like, where's the medical element? And so yes, medical polytherapy is a child life based modality. Um, and I'm trying desperately to bring it into like the clinical mental health sphere.
Yeah, well hopefully we can do that a little bit here today because, um, this is really fascinating. Mm-hmm. , um, I have a therapist working in my practice. She works with children. I don't work with children. Um, I work with some older teens, but, um, not young kids. And so can you tell us a little bit about, yeah.
There's medical play therapy. What are some of the, maybe even like a made up case study, like what are some of the things that people come in with and. Specific examples. Obviously not with a real client, but mm-hmm. . Yeah. So to me, medical play therapy is this like beautiful love child of child life and psychotherapy.
Honestly. , maybe we can, maybe we can even, I actually don't know what child life is, . I feel like I probably should, but I have never heard of that before. Can you explain that? So Child Life is a certified professional who works in a hospital setting who works as an advocate, um, who's based in the mental health sphere.
So this person understands medical terminology, understands the procedures the child and the families are going through, and they're the ones that'll say, okay, like, you're receiving an iv. Let me show you on this bear what this looks like. Mm-hmm. . And let's talk about what feelings are coming up. . And so it's that very similar.
Okay, I'm gonna give you the logistics of what's happening. I wanna help you process those feelings in the moment so that when it comes down to the pr to the procedure, the child feels more comfortable at ease and like they have someone on their side. Um, awesome. It's a really neat position. I, I know that there's a pretty significant shortage, especially with Covid.
And so when I bring it into the therapy space, so part of what I've done to do that, Getting medical terminology education for myself, because I know as someone with a chronic illness, sometimes it's exhausting to come into a space and have to educate somebody and have to say like, okay, hold on. I just gave you a term.
Do I, should I define it? Um, so part of that means having a pretty basic baseline understanding. And when I bring it into therapy, adding in the elements of play to express what it's like. So it's not as focused as in a hospital where there's probably a timeline crunch going on. Mm-hmm. , so for example, If I am with say, a four year old, um, who has experienced seizures and they come to therapy, usually by the time I'm with them, I have like a release of information to talk to a neurologist.
I talk to all of their care partners and I wanna understand what the experience of seizures are like for the child. And so we won't go into like the nitty gritty of what it means physiologically, but we will talk about, okay, when your body tells you you have to sit down, what's your heart telling you?
Is it telling you you're scared? Is it telling you to run and to flee? And so part of therapy will be deconstructing that feeling and saying, okay. If your friend was feeling like this, how would you wanna talk to them? And we practice that with each other in this more contained way. Um, and we try to make it a safe experience for them so that the next time it happens, it's validating the experience of the fear, maybe being out of control of our body, but bringing our power back to the child.
Yeah. That's amazing. So glad that that exists and I'm so glad you're doing that. Um, how long have you been, when did you graduate? So, I graduated with my master's in 2020. I graduated through a YouTube video, , which yet, it wasn't fun, wouldn't really recommend it to a friend, but I will say, Beginning, I mean obviously my internship and my practicum experiences were before Covid happened, but knowing my passion for chronic health, um, or chronic health concerns and things of that nature, I'm really glad I graduated when I did because of things like long covid that exist now.
Um, it just kind of covid gave us a lot of things, but I think it gave us the opportunity to destigmatize some aspects of chronic. Yeah. What is currently happening with, I feel like, so I have Lyme disease and well had, have, I don't really know cause it's such a controversial illness. Um, but that's kind of, that relates to my question, like, where are we at with long covid right now?
Um, because I think when it first, when it was first recognized, a lot of us with things like, um, Epstein Bar virus mm-hmm. that, you know, stems from mono as a kid or, uh, Lyme disease or these chronic viral, um, conditions, we were like, yes. Like we're gonna finally be recognized. Mm-hmm. and I think. I even like, a few months ago, I heard something along the lines of like, no, like long covid isn't a thing, isn't a thing.
I'm just curious, have you heard like where, where are we at with, with mm-hmm. , long Covid? So in terms of my experience and what I've noticed in the field right now, there's kind of a fear. To call long covid what it is, which, I mean, you're right, like this is a really big departure from even where we were six months to nine months ago.
Cause I feel like around that time people would say like, Hey, I'm experiencing long covid symptoms. This is what it looks like. Here is how I can make this space accessible. , but now there's almost this apprehension of disclosing that you're experiencing long covid symptoms. Because, I mean, I think Covid has been politicized for a lot of reasons, but now it's reached this internal shame and invalidation, and so now people are questioning their symptoms, which is you and I both know.
It just makes them worse and come back twofold. Yeah, it does. Yes. Yes. Can we maybe talk about that for a moment? So, because this, I like the way that you just said that, and this is really the, like what we're talking about on this podcast all the time, it's not in your head and stress doesn't cause pain, it doesn't cause an illness.
But when you have all this shame and guilt and which leads to things like isolating and secrecy and. Spiraling, ruminating thoughts and things like that. It does exacerbate symptoms. Mm-hmm. , and I think that's what you're speaking to right now. Can you say anything else about that? Yes, and so I think I, I don't love the fact that I , I manage my own chronic health condition at the same time, but I do think it's helpful because I have felt it.
100%. Especially as a clinician working during Covid, I've had my own concerns and I've been very lucky to stay physically healthy, whatever that means, , um, with my baseline of being healthy. But I have felt stress and I've seen what that looks like for me and that own internalized shame. And I think at the end of the day, what's been happening for people with like long covid with chronic health conditions or even with covid, is this overall like disconnect and at times dissociation of self and there's now this big anxiety of, I don't feel comfortable speaking what I'm feeling.
I don't know if I wanna say that out loud because I'm not sure if it's going to be invalidated. Stigmatized or oppressed. Yeah. Yeah. And to bring it back to this concept of play therapy, um, it sounds like what you do with within play. It touches on all of this stuff in such a, um, non-threatening way, rather than trying to, well, let's confront your thoughts and like, you know, well, that thought's just not true when reality is, like, a lot of times these thoughts are true, like people do have their judgments and they do have their, and so it sounds like play therapy very much like some of the somatic work that I do is helping children.
Expose themselves to certain, um, fears or thoughts or things of this nature. And then, and then in that experience learn, oh, this isn't, like, this isn't super dangerous. This is just an experience. It's an experience that I move through and learning how to gain support and, and that inherently helps my nervous system calm down and maybe also some symptom.
Absolutely. Honestly, you hit the nail on the head there and I think something that I found like very special in terms of that kind of medical play-based therapy is, I mean, how often do people with some kind of health concern get a space where they can spend time? With their health concern, because I feel like normally when it's brought up, it's in this kind of more white coat setting where you are disclosing your symptoms, you're disclosing how you're feeling, how things were going.
But I know that even for some like little ones, we'll name. Their chronic health concern. I'll say, okay, if your diabetes with someone in the room, let's give them a name. Is it a friend today? Today? Does it feel like a shadow that's just kind of bothering you? Does it feel like a mosquito? And I think giving people of any age, that space to spend time with their health and with their body in that way.
I mean, you see it in somatic work. , we're not used to it anymore in Western society. So it's really special to see both the connections and the disconnects there. That makes perfect sense. Yeah, I mean, just play in general, whether you have a chronic condition or not, we just like, dunno how to play in this country, um, because play isn't productive and that's really all we care about.
But I mean, I would argue that it is productive because the more fulfilled you are and. , the more breaks you give your nervous system from this, like hyper productivity and always need to be like on the move. Which yeah. That, that's like we need to recover just from that. Mm-hmm. , um, alone and we just dunno how to play anymore.
We don't at all. And I even noticed some children. Just don't feel comfortable starting the play. And so sometimes if we can't even get there to start as a baseline, we'll do what I like to call like the yawn game. Um, and it's obviously we're trying to stimulate their vagus nerve and have their whole nervous system kind of decompress and regulate a little bit.
And so I'll say, okay. We are looking for a yawn. These are some of the cues that I think we're getting closer to it. Let's see if we can find the yawn today. Here's how we can maybe coax it out a little bit. And so we're really channeling like that mind body relaxation piece. Um, but you're right. I think, I mean I've had some kids come in after school and they just wanna sleep.
And I think it just shows the dramatic need for more of this mind body play, this more connection based therapy. Um, especially with little. Yeah. Oh man, that's really cute. I like the yawn ex. The yawn exercise. . Yeah. This is really fascinating. So do you work with only. So I work with, um, I like to balance my caseload kind of 50 50 with children and adults. Um, I really like to see people at all different parts of their kind of like diagnostic and maintenance journey with their chronic health. Um, and I also, it's a nice challenge because I never know what I'm going to get with a wide variety of ages.
Yeah. And do you work with parents too or do you, you just have, do you like, refer out for family therapy or what do you do? So, I typically don't do family therapy. Um, I'm lucky to be at a practice where there are other clinicians who do see families, but I do also work with the parents. Um, I like to let them know that, Their child is the one in control of the room.
And I actually ask the child's permission to talk to the parent. Um, which obviously like legally, I make sure that the parents give consent and things like that. But once that is established, I make sure that the child knows that they're in control because this is usually one of the only times that they are with obvious boundaries of kind of safety you respect, things like that.
Um, so I do work with the parents just in terms. How to support their child, what this even means. And also how to help advocate in other realms, whether it's school with their stakeholders and their health, things of that nature. Yeah. And what are some of the experiences that children have, like from especially just being in the hospital over and over again or being in doctor's offices where like the language is hard enough for adults to understand, let alone.
So what are some of their experiences and then that you then help them normalize or, or get, um, normalized through play? Mm-hmm. . So a lot of the time I've noticed that if a child enters a doctor's office, they already feel like there's something wrong with them. And I've noticed that this is a difference between.
children who have those quote unquote normal checkups and then children who don't. Um, and I think I could honestly go on a soapbox about our idea of normal , but I think it's, what I've noticed is a lot of kids now have this conditioned response to entering medical facilities of they're already feeling anxious and they're already experiencing fear and anxiety and that kind of jitters in some kind of way and.
Over time, it's led to this mentality of brokenness. And I mean, especially when we're thinking about the medical model, it, it is about brokenness. It's, it's so flawed for so many reasons. And I think the more kids experience this very white coat medical model where they're, they're hearing words that aren't being defined to them, it's scary and it feels foreign, and so it makes 'em feel like they don't have control of their body.
They aren't in control of their life and how they're treated. There's no autonomy there and that they're broken. And I mean, I've seen kids as young as four years old and it's like you're gonna tell a four year old, but they're broken at such a young age. It wears on someone's psyche over time. Yeah. And it's your, it's your normal if it's happening from such a young age and you just don't even know anything different and.
Sometimes when you try to work with clients around that concept of like, them not being broken, it can feel really invalidating. Mm-hmm. . Um, so obviously we, we move gently and lightly and with lots of validation and lots of compassion because these people have usually also had people, they've equally had people tell them how broken they are and then tell them to push through it.
And, well, you just gotta, like, you just gotta push through it. Like you still have to, you still have to get up and you still have to go to school and you still have to do X, Y, and z and. , there's just no, um, accommodation. Mm-hmm. . So there's this really conflicting view of like, what it means to be sick and how I, I've been told that that's me being broken.
Yet I'm expected to do everything just like everybody else. Mm-hmm. . Absolutely. And also on top of that, asking for help. Makes it worse, . So there aren't a lot of options and choices out there. Um, and so I think therapy is a really good opportunity if someone feels comfortable and ready to talk about what those experiences have meant to you over time and how it's impacted just your view of self, and especially as we're in kind of a body positivity realm of our world, what posi body positivity means if you aren't happy or you don't feel at home in the body that you're.
Yeah. What does that look like with younger kids? So for a lot of younger kids, you're, I mean, as you said, they don't have a baseline that other children do, and it's this idea that, okay, my body's going to tell me I have to get sick more often. Um, and so it's. First of all, normalizing their experience and affirming their experience and giving them connections, and then finding ways that they can exist in their body.
Because I feel like, especially right now, a lot of kids, especially those preteens and those teenagers, see things like body positivity and it doesn't feel, I mean, attainable to them. So sometimes our goal is body neutrality. . Um, and I think that's where I like to start with the really little ones is, okay, what is neutral in your body look like?
What does that mean in terms of your day-to-day functioning? And do we want it to feel positive today? And if we don't like, that's okay , but do we want it to look like positivity tomorrow? And it's not pushing an agenda that a child isn't ready for because if they're managing their health in a certain way, they've already been pushed without their.
Yeah. Yeah. I think one of the things for, that's really important for parents to understand, and this is with just children in general, we often see a behavior or we see a thing that we feel is like not conducive to being a fully functioning adult, and then we wanna just like, Hound down on that behavior and make it go away and fix it right away.
And it's like when you understand child development, you understand how important it is for children to go through these stages. I mean, you were talking about, um, them being in control, right? Mm-hmm. , and I think that's so hard for a lot of parents. It's like, what? No, like I'm the parent, I'm the adult. And it's like, yeah, but autonomy.
Literally a stage that they have to go through. They have to know that they are capable of having control in this world, and once they feel capable of that, they're actually then more willing to let go of some of that and allow you to guide them and lead them more. But if you just kind of like try to eradicate it and they never get to experience what it's like to be in control, well now you have someone who's fighting to find control for the rest of their.
Absolutely. And I think a lot of the time I've noticed sometimes it can be a pattern with parents is, I mean, parents are heartbroken. They, they bring a child into the world and all of a sudden something's happening. Something, something is wrong to them. And. I mean it's, I can't even imagine what that's like.
I know I'm someone that manages my own health. I don't know what it's like to have a child with a health concern, but I do know that it has to be earth shattering, groundbreaking, and heartbreaking for their own reasons. And I know I've noticed that a lot of parents can sometimes get stuck in that realm of that shock and that trauma of.
My, my baby's broken and I just wanna fix them. And sometimes parents carry their own guilt and without knowing it can be transferred onto the child. And sometimes the child is more body neutral and body positive than the parent is. And the child is thinking, okay, like, this is my body. This is how I work.
This is me, but my, my parents. Are are nervous and they're sad that this is me. And so I think something that can happen with therapy is bridging that gap in a supporting parents and saying, okay, where can you find support because you deserve it and you should have it. And how can we make sure that when you're with your child you feel that joy and you see that they aren't just a diagnosis, this is still your child and you're also not at fault.
Yeah, I think the. Peace there is so hard. We have such a narrative in this country of like, and I think it just stems from, um, puristic views. Mm-hmm. of like, you know, if you, if something is going wrong, it's cuz you've, you've done something to deserve it. Yeah. Um, and even if you're not, uh, religious or you know, Ascribe to like any, any theology at all.
I think that, that it's, it's still very pervasive in our society cuz that's kind of how our country was formed. And so there's just this view that, um, it's your fault and, uh, it's, it's not, I think that's the biggest part about acceptance is understand. I think it gives people a sense of control too.
Mm-hmm. , I think if it's my fault, then maybe I can do something to fix. . So I don't wanna just rip that away from people and, and force them into acceptance of like, it's not your fault, but at the same time, life happens. Mm-hmm. like illness happens, you know, COVID happens. Um, and so helping parents understand that, I think it's important.
Um, you didn't do anything to your kid, you didn't do anything to deserve this. Um, but going back to that piece of. How we react to our illness or how we react, how we react to stress can exacerbate symptoms. Mm-hmm. . So we wanna do everything we can to, um, learn how to calm ourselves down, especially as parents.
And I am a parent, so it's, um, I think that's the hardest part of the work is just constantly looking at your own reactions and. It's really easy. You don't wanna go down a path of, of con, when I say constantly looking at your own reactions, that can easily lead into like anxiety. Mm-hmm. and am I doing this right?
And we don't, we don't want it to go that far. But just a level of self-awareness, a daily check-in with yourself. Am I responding from a place of fear or am I responding from a place of growth or things that I want out of life? And that can be hard to differe. Absolutely, and there's this idea of co-regulating and if you're a parent with a medical concern, concern a child with a medical concern, all of the above or none of the above, I think that that is an experience that can be so helpful and healing for all parties, because as a parent you can show up as you are.
And if you're having a rough day, if it is just, it's not a good time, you can bring that to the table in a way that's not harmful to the child that's near you, but you can work with the child and say like, Hey, I don't feel too well today. I feel like there's a balloon in my brain that kind of feels like it's going to pop.
And say like, okay, what's your body feeling like today? And then taking that and saying, okay, I want to take a few deep breaths so that my balloon doesn't pop. What do you wanna do for your body right now? And it's having that experience so that the younger person that you're talking to understands that it's, it's not only it's okay to talk about what you're experiencing, but regardless of what it is, it's, it's acceptable and it's wonderful and we can do something with it if you want it to change.
Yeah. And for those with younger kids, um, like infants where the communication piece isn't there. , do you have any tips around co-regulation? I, I can speak to it too, but I wanna hear from you as well. Mm-hmm. . So I think it's that somatic experience and it's that somatic bonding that will be really huge be, I mean, obviously infants are so highly intuitive and they're so connected to their people, and I think it's that idea of if you're with an infant and you are not regulated and you feel like you are just heightened and you engage in some kind of decompression and relaxation, That will be felt in the room.
Um, especially if it's in combination with something like a gentle hum or singing or just talking about it out loud. Even if there's not that language piece, they can still feel it. And there is the sensory adaptations going on. Yeah, absolutely. Yes, exactly. It's, it is a somatic experience, a body-based experience.
You're and your babies, they ins they really do understand language more than we think they do. , um, They obviously just can't understand the, the conversational aspect, but they do, they, if you have some kind of mantra that helps you, I've had several that I had to create throughout the last year. My kid will be a year in three days, and, uh, yeah.
It's, it's, it's incredibly difficult, especially if you grew up in an environment where co-regulation was not a thing. It was actually just. You are not allowed to show your emotions because your emotions are too disruptive. Yes. Um, in one way or another, whether it's because mom or dad got, or caregiver got angry or maybe they just shut down themselves.
So learning to co-regulate is, it really is all about your own self-regulation and learn and knowing that the moment is going to pass. Mm-hmm. , if you can have faith in the fact that the moment is going to pass and that nothing is permanent, nothing lasts forever. You're able to stay a little bit calmer, um, in when your baby is crying for three hours straight.
Yes. You dunno why and you can't figure it out. Um, and you just think like, oh my God, am I, am I hurting this baby? Like, do they think I'm the cause of their pain? And they, these thoughts come up. Um, and yeah, to stay, to stay grounded doesn't mean you just look like a zen monk. You know, you know, just, just meditating while your baby's screaming in front of you.
Absolutely . I think that there's this like common misconception that parenting is in like the polar opposite sides of the spectrum, that we're either this like Instagram parent that is not typically realistic of being always calmed, as always regulated just on top of things all the time, or. We're, we're a bit of a hot mess.
Um, I think that balance that's truly healthy for everyone is in the middle because, I mean, the human experience is messy, , and I think it's part of those where it's like, yeah, like we wanna co-regulate. Sometimes. If that doesn't feel realistic, what can we do instead? How can we use our support system to tap in and tap out as needed to really take care of you first?
Yeah. And obviously that will bring us down the rabbit hole, like support systems and what's . Um, because yeah, I mean, we just don't live with our families the way that we used to. Like we don't live, um, you know, with grandma and grandpa and, um, aunts and uncles and uh, and even within the quote village like, We don't, we don't even live in, we don't live in walkable areas.
We have to drive everywhere. Especially if you live in Atlanta, you know that you don't wanna go anywhere. So Yeah, you don't have somebody, you don't have your neighbor who can like, hold the baby for an hour while you just, and I, I read somewhere it was like every, um, Somebody had posted this on Instagram.
It was like, uh uh, over Christmas break. Parents remember like when your kids are around every three 30 seconds to three minutes, your intention span gets pulled away. Like your attention gets pulled away to something else. . Mm-hmm. . I was like, that's it. That's the crux of it. Like that's why this whole year has been so difficult because you just, like, your brain gets pulled into a different direction.
and part of it is like going, you know, growing up, going to school and all of our, the way we do in this country, like you're, you, you learn that it is imperative that you remain focused. Mm-hmm. , you stay focused in class, you stay focused at work, and then you have a baby who's like, uh, no, you're not gonna be focused for more than 10 minutes at a time, for a year or more, depending on how long you stay home with them.
And, Yeah, to have your, your attention span like pulled away over and over and over again, also makes it really, really hard to co-regulate. So when you have a support system who's able to come and give you relief, you can, one, have this time where you can focus for longer stretches of time, but two, then obviously there's.
There's other, there's other thoughts I have around that, but I'll pause and see what your thoughts are around that . Absolutely. And I think that this idea of support is obviously an immense source of privilege on its own, and there are so many factors that come into having that support network and needing that support network too.
And I think that's absolutely something that. Should be touched on all the time. And you're right, we are programmed at such a young age to listen to instructions, to follow instructions, to stay on task all the time. And then when we're put into these situations that feel a little bit more real life, that's not how people typically get through it.
Um, and I'm even thinking about being a clinician in therapy. I, my brain is bouncing around every few seconds, whether it's too okay. How can I listen to what my client is telling me and help them process and to synthesize it? What do I know about theory and how can I utilize intervention with them? Also, how am I doing in this moment?
Because that needs to be felt too. Like, okay, do I feel like my blood sugar is about to take a hit and do I need to correct? Am I starting to feel nauseous? And it's this idea that I feel like people have been. Told that like the multitasking experience isn't healthy and I'm sure that there is data to suggest that there are elements of it that aren't helpful to us.
But at the same time when we're thinking about things like parenting and co-regulating, it doesn't exist in a vacuum. Oh, 100%. I think I'm right there with you on multitasking, I think. Yeah, cuz when you have a baby, that's literally all you can do is multi. , you have to think. And it is similar to the experience, like you said in therapy as a therapist, you're thinking about fear, you're thinking about intervention, you're thinking about what the client's feeling, what you're feeling, all of those things at once.
And with a baby, it's the same thing. Um, and so for parents, it's really learning how to, it brings me back to the concept of like frustration and intolerance or low frustration tolerance. Um, and every time you get pulled away from like, into a different, um, thought process or you get distracted, If you have a low frustration tolerance, it's really, really frus hard to deal with.
It's just so frustrating. So it's increasing your ability to deal with frustration and accepting to a certain point of like, this is how it is. I'm not supposed to be able to just sit down for an hour and focus on this one thing because that isn't real life, like real life requires attention to several different things at once.
Yeah, absolutely. And it's also that awareness that sometimes our body might define our window of tolerance that might not align with mentally where we're at for the day. Um, like I've even voiced my own frustration sometimes that my mind is working a lot faster than my body is some days. And it's like, okay, where is that window then?
And where can I find that connection of here's a balance of what my body's ready for and what my. Going to sustain today and where my mind can be and processing what that looks like. I do that a lot with, I mean, in smaller ways, children, but a lot of the times I do a lot of that work with adults as well.
Yeah. I like how you said that the body, um, is what determines your, your window of tolerance. Because I think a, like us, obviously, especially with therapy, we are often talking about what you can control versus what you can't control. And we're using our brain to figure that out. And that's important, that's a part of it, you know, talking about it and, and having a cognitive understanding around it is important, but you can't think your way out of or into your window of tolerance.
Mm-hmm. . Um, if your body, if your blood sugar's high, like, and, and you don't even know it cuz let's say you don't even have blood sugar issues, but you know, you really did have. A lot of stress or food that contributed to a high, um, you know, blood sugar today and now you're feeling really antsy in, in, in session with your client and you don't even know why.
Like, and if you think it's all in your head, then you're like, oh man, something must be triggering me about what they're saying, but has nothing to do with that. Mm-hmm. . So there is so much to pay attention to. Um, learning your body is such an important, aspect to. What do you do for yourself that helps you learn your body?
What has been really instrumental for you? So I think for me, my relationship with my body has been a true rollercoaster, and I think that this is really important to also know true that, I mean, I am, I'm a white woman in the United States. My experiences have immense privilege over so many other people.
And so even in the days where I don't feel seen or heard, I mean, it's kind of a drop in the bucket compared to others. And so I think my relationship with my bi, with my body has been that of a lot of internal shame and invalidation for a long time put into adulthood. I've learned how to coexist with it some days, um, and to embrace that body neutrality kind of head space when body positivity just doesn't work for the day.
And so that for me, it looks like, okay. Before I go to work every day, I spend time with my body, um, in a way that feels good, whether that is doing strength training at the gym, which I love, or going for a walk or even just sitting for a few minutes and having some water. And I think having that start to the day of honoring my body, it sets me up really well to, I mean, have the rest of my day be about other people, , and then also managing my time, um, things.
Having that break, and even if it's just a few minutes between clients to take a breath. If I'm wearing a mask, taking my mask down and just to regulate, um, and I talk to a lot of my clients about this is we will have a human experience in the therapy room and sometimes they'll see me as a human, which that could mean.
Hey, I'm gonna ask for permission If I eat something small because I'm feeling my blood sugar drop, or having some water, or doing something that's just honoring my physical needs, it's just bringing that into the room, um, more than anything and not checking it at the door because I, I can't . Um, and it wouldn't be fair to tell my clients that they deserve to honor their body if I wasn't doing it myself.
Yeah, I often have, um, clients. And so sometimes I even start a session and I'm like, I'm just finishing up my breakfast. Like, and they all know that they can also eat in session. That's not, not an issue and it can feel so awkward, but I'm constantly educating. I'm like, you don't even have to look at the screen.
Um, you can look away from the screen while we're talking. This is not class. You don't have pay attention to the teacher. Um, and you don't even have to pay attention to me. This is about you. So what does your body need right now is really. Absolutely. And there's some experiences where a lot of my clients will know that.
And I mean, honestly, before I even think about this and say it, I realize that like my graduate school professors would. Oh, runaway screaming if they ever heard me say this in a session. But sometimes I look at my clients who are experiencing something with their body and I say, Hey, this might be a situation where we can't coping skills our way out of this one
Um, and sometimes it just takes that immediacy for a client to say like, Thank you. This is hard, and doing box breathing isn't going to change this right now. So having someone to share that experience with is such a powerful experience. Yeah. Uh, 100%. And goes back to, um, uh, co-regulating with when we were talking, when we were talking about co-regulating with parents.
Um, . The goal is not when you, when you are tr attempting to co-regulate, the goal is not to get them to calm down. Mm-hmm. , the goal is to regulate yourself while they are having their tantrum or their freak out and allowing for them to have it within a contained space and you not getting worked up. Um, and if you are, then you are managing that and, and not going outside of your own window of tolerance.
So it's figuring out. Again, even as I'm saying this, I'm like, I know that somebody who's hearing for this for the first time will try to, will willpower their way into that situation. And it takes such immense practice. It does. Um, a lot of practice. It really does, and especially sometimes, especially within this chronic illness community, tapping into our feelings might not be attainable on a certain day because it's one of those, I've, I've noticed it a lot with, um, a lot of my clients, especially as we're in cold and flu season, R s V season, this new uptick of covid that's, um, here, but , it's one of those where sometimes I'll look at a client and say, Hey, I'm wondering how you're feeling physically today, because it seems like your energy might be focused towards things like keeping you awake, managing your headache, managing some muscle tensions and aches, and that access of your feelings might not feel attainable today.
Yeah, yeah. And just having somebody there to, like you kind of said earlier, um, to see you in that mm-hmm. and to hold space for that. And to not have to think about like, I'm supposed to be improving right now. I'm supposed to be practicing this skill, or I'm supposed to be doing something to feel better.
Sometimes just feeling the thing and not trying to change it. Well, that's actually the entire entire process is like, how do we just let you feel this and not try to change it? Which is, it can be incredibly dysregulating for a lot of, um, adults. Uh, I think kids maybe are a little bit more. Um, can, uh, it's a little bit more tangible for them because mm-hmm.
they're, they're already at least familiar with play. You know, we still let them play a little bit as kids, not as much as we should. Um, but yeah, it's. It's difficult, but it really, that's the most important part, is having somebody who can look at you and say, you're allowed to feel that way. You're allowed to thrash about right now you're allowed to have a tantrum because we know the more so, and this is where the self-regulation piece comes in, the more you understand that these things are temporary and such a, they're just such a normal part of the human experience.
You don't have to yourself as a parent or a therapist freak out. That this kid is breaking out because you know it's going to calm down if you just provide the, the, the support. Absolutely. You don't have to fix it. And you're right. Like it's scary. It's scary to embrace that feeling of chaos and that feeling of being out of control of whether it's your emotions or your child.
Um, and I mean sometimes if it doesn't stop what to do next and things of that nature. And I know that this idea of sitting in our feelings, I feel like is a phrase that's. All the time. It seems like a buzz phrase on like Instagram ads and bloggers. It's like, let's sit in our feelings. But we really have to unpack what does that look like?
Because it's not comfortable for the vast majority of people in western society because it's not typically accepted. I'm even thinking about with men, like I, I cannot think about a time where I've worked with a man who has. Completely comfortable sitting in his feelings. And so it's one of those where I think about, even for me, one of the most impactful experiences that I had in my own therapy post-diagnosis was a clinician looking at me and saying, I'm not going to apologize or congratulate you on this diagnosis, but I am going to invite you to think about how we can grieve the body you thought you wanted versus the body that we have today, regardless of the label.
That like blew my mind and it, it makes you have to sit in it and think about what has this been like for me emotionally? Away from the terminology, away from the jargon. Where am I now? Yeah, that's a really, you said that was your therapist post-diagnosis? Mm-hmm. . Yeah. Yes. That's beautiful. I'm glad they must have been also trained or had experience with chronic illness.
Oh yeah. , absolutely
Yeah. Um, I've talked about my own past therapist on this podcast a lot, but she, I would not have gotten my diagnosis without her. Mm-hmm. . So, um, and that's part of why I do what I do too, too cuz um, I think we, I think every therapist who's been on this podcast, we all have just realized at some point or another there was not enough support in our life around the medical system, around feeling what we're feeling around having really difficult experiences and,
So that's what we're here trying to change, is to be one more person in the world who can hold space in that way. Cause it's not easy to do, you know? Absolutely. And I mean, as you said that I was thinking about, I mean, I only have my diagnosis because a nutritionist said something, and I mean, it was all of these years of speaking up and being told that I was too much, I was being dramatic, things like that.
And then a dietician looking at me and saying, oh my. You aren't being dramatic, something's wrong. And the sad part was it didn't take me using my voice. It took another healthcare provider to use their voice, um, in order to seek that support, knowing that, I mean, our healthcare system, I mean, there's so many inequities and inequalities and there's so many disparities in our healthcare system.
So knowing that I'm very grateful to have gotten a diagnosis and to have access to some kind of support. But I mean, there's probably more people that don't have that than. Yeah. Yeah. I think just access to healthcare in this country alone is a privilege. Mm-hmm. . Um, and we do talk a little bit on this podcast about functional medicine and like paying out of pocket for doctors, which is even more of a privilege.
Um, but it's interesting, I'm noticing a shift even within functional medicine of like, especially as more and more people are wanting to use insurance, there is now more and more a shift again, that's going kind of back to that like super medical model, lower time with visits. How do we, like, what is the exact symptom and what is the thing that we can give to like, you know, just target that symptom.
There's just, it's anytime money is involved, I feel like we're always trying to, um, isolate the problem. But we're whole people. We're whole people. And I think that's why two people think, like if you are referring me to a therapist, it's because you think it's in my head. It's like, no. I mean, maybe some yes, some doctors probably yes.
But um, that's not what we're here for. We are here to be one part, this whole problem where just a whole, it's the holistic approach. Um, and I think, you know, indigenous cultures, they know this. They've known this forever. , we're the ones who kind of are still continuously trying to learn that, hey, um, support happens when you look at the whole person, and not just one tiny aspect of a problem.
Right. We're not a mechanism, we're not a, um, we're not machines. Absolutely. You know, that analogy is used a lot for the body, but that's just not how it works. Right. And it's one of those where even if we're quote unquote healthy people, Our mind can sometimes lead us astray. And it's a thing like even with a common cold, there's evidence to suggest that having that cold impacts our feelings and our executive functioning and our regulation and just how we go through the world.
And so I think right now, I mean it's understandable that I'm sure at kind of the economic level, it's gotta be hard to find ways to delineate care and reimbursement and insurance. That's gotta be tough, but. . Um, there we're obviously missing the mark on that connection, and it's this idea of, okay, how can we support the whole person because we're not, and it's, it's continuing to get worse.
And why do people have to feel stigmatized and like they have to go through a traumatic diagnostic process to just be acknowledged? Yeah. Yes. You're, I like your example of the common cold. . And you know, even this conversation is, you know, the privilege within it, which just comes down to how are, like, there isn't a, there is no support for time off within our, the corporate, whether it's corporate or um, government jobs, it doesn't matter.
Like time off is just not a thing in America. And to have a cold, you're right, it does, it affects your ability to perform. But we are just trained to believe that nothing is supposed to affect your ability, ability to perform, you compartmentalize. And that's just that. . Um, and then we, I think that's it.
Like part of the problem too is like when we can't, then we think that there's something drastically wrong. Like it has to be, it's like all or nothing. It has to be, you are just so severely ill and disabled in this like, horrible like word that you know, when really it's. , everybody goes through disability at some point in their life because of the systems that we're live, what we live in, um, whether it's covid or a really bad cold or the flu mm-hmm.
or something that's a more chronic, condition. Absolutely. And it's this idea of if our expectations of what we should be doing are based on perfection. We aren't going to hit them, like period. And just the idea of thinking, okay, you have to get this done. You can't have feelings. That's not realistic.
But that is, I mean, ingrained in a lot of parts of our society of check this at the door. Which, yes, at the end of the day, businesses still have to run, projects have to be completed. We still have to function, but it, it doesn't take these big, massive overhauls. It can just take this moment of. Talking to a manager or a boss if you feel comfortable and if it's a safe situation to do so and saying, okay, here's where I'm at today.
I didn't get much sleep because my six month old has really bad acid reflux. I wanna get my projects done today. I will get it done in the next 36 hours. I might just work different times. I might be completing this at 3:00 AM cuz that works with my baby's schedule and it's having room for humanness.
Yeah, I agree. I think while our whole system is, um, always trying to work against the ability to be able to do that, I do think there is at least some room for, especially in all honesty, I think Covid helped with that. Mm-hmm. and lately people are trying to get back to this like rigid world. But um, and during Covid there was so much flexibility, uh, and I think people are really grieving more right now.
Um, this. Going back to the old normal when we kind of were getting used to the new normal. Mm-hmm. , and it's that idea of like hustle culture. Oh my goodness. Hustle culture is one that I have spent a lot of time processing with people because I mean, I'm thinking about like, my fiance works in corporate America.
He works in technology. The man has a work ethic I've never seen before. I am in awe of how hard he works and how dedicated he is to solving problems. That hustle culture for him works beautifully. It makes him really fantastic at completing projects. It makes him great with divergent thinking. But what happens if he's tired?
What happens if, I mean, heaven forbid he wants to take a break and it's this all or nothing idea that we really have to start deconstructing of. , how can we honor these really wonderful attributes of people that created hustle culture, like drive, like initiative, but to use it in a way that's sustainable long term.
So it's no longer a hustle. We're, we're jogging, we're not sprinting anymore cuz we can't keep that up forever. Absolutely. Absolut. and I think there's a time and place too, like, um, when you are younger, like young, in your young adult years, you just have more energy . So, you know, even if we had more of this understanding that maybe you work harder in your twenties mm-hmm.
and you know that you're working to kind of be able to work less as you get older. Yes. I think there's a little bit of that conversation as in like, when I retire, but. You're going, you're telling a 20 year old about like retirement when, you know, in your sixties or seventies, um, that doesn't, that doesn't resonate.
Um, we just really don't understand transitions in this culture. We kind of just feel like, well, this is what I'm doing. This is what I'm always gonna be doing. And then when there's a huge shift, as there should be a transition as there should be, there's a lot of grief that comes along with that. Any I absolutely agree.
Yeah. And, um, how are you on time? Do you have to get off right at time? Oh, I'm good. I just wanted to ask, um, you were a contributing author in a book, what we didn't see coming mm-hmm. , um, you with chapter one. Right. Can you tell us a little bit about that? So, oh my goodness. So what we didn't see coming was, it's pretty much like an anthology style book.
So meaning there are different authors that wrote every chapter and for some reason I was chosen to write chapter one. Um, this was like after I had already submitted it. Um, so it's authored by Dr. Beth Tali, who I worked under and I studied under in my undergraduate career, and she read my submission and said, this needs to be how we start this book and.
Oh my goodness. I building I've ever felt as seen and as honored as I did in that moment. And so my chapter is all about my experiences when I was abroad. And what it was like to be outside of our culture where I didn't speak the language and how we connected about our mental health and our physical health in the education system.
And so I was in Mona, Italy and I was working as an English teacher and a special education teacher in a first grade classroom. Keep in mind, I really didn't speak much Italian. I am lucky to have grown up in a very Italian family, but aside from words that I probably can't say in a school, , I, I didn't really know too much Italian.
I understood the cultural nuances that I have in my family, but complete fish out of water experience and. So at the time when I went over, I was experiencing some anxiety and grief in my personal life and the experience. I mean, it was life changing because I understood what it was like for other people in other cultures to talk about what they were experiencing.
All of this in like a gate of a game of charades. And so I remember being in a classroom and there were kids with all different needs just mixed in, very normal. And that was it. It was, it was normal. Even children who needed some one-to-one aid and assistance, this was life and they weren't stigmatized.
They would be walking around the classroom if they needed to move their legs. Children didn't have to ask to use the restroom or honor their bi biological needs. It was a really interesting experience and I got to see what it looked like long term in terms of just their health outcomes and their mental health and how.
Translated overseas. And so my chapter is really about how non-verbal communication taught me more about communication than any experience I've ever had in the us. I love that. I think that goes back to, um, when we were talking about like just having your attention pulled away and how we don't realize like that's a normal part of life.
This reminds me a bit of Montessori method, which mm-hmm. was also, it's very Italian, so that makes sense. Um, but as a Montessori teacher, you're taught how to, um, and I, I know there's accredited, not credited at all, but when you're really, um, trained in, in Montessori ways, you're taught how to look at the kid.
and see their not like you're saying their non-verbal needs without them telling you because they're not verbal , they're not verbal yet. So, um, we as the adult take on that responsibility to help them to un show them when he, when you communicate this way non-verbally, we understand you and we're gonna help you and we're gonna support you in that need, and we're gonna teach you how to take care of that need.
But then you bring a kid into an environ. Where you know, you have to ask, ask permission for everything, and you have to follow directions exactly as you were told on the first time when they're not even developmentally. It's not even developmentally appropriate. Um, how quickly you learn to shut down everything in your body.
Because if you're thinking about the fact that you have to pee and somebody is telling you, shut up and listen, like you're not paying attention, it's like, yeah, cause I have to pee like , right? Absolutely. Yes. And so I actually studied the Reio Child Development Method, um, in Reio Amelia in Italy. So I mean, it was.
Truthfully an out-of-body experience, cuz you're right, it, it's a bottom up and top-down approach all at once, starting with the entire child, mind, body, spirit, and everything in between. And obviously a lot of the issues that we have now comes from micro and macro level systems, but at the end of the day, like we're not seen as whole people anymore.
That's true. It's true. This has been a great conversation. Are there any other thoughts you have around this that you wanna. Um, yeah. Anything else that comes to mind? Yeah, so I think that it's really helpful to touch on the fact that therapy, as you said really beautifully for someone who's experiencing a chronic illness or has before, can feel unnecessary.
Sometimes it can be this idea of, I have been to four different offices in the last week. I've, I've paid my copays. , I don't wanna do another one. And that's understandable. And so I think that sometimes there's a hesitancy to, to approach therapy, which is honored. Um, but I will say it can be a really beautiful experience when you're ready and if you're ready.
Um, and I think normalizing that apprehension because of that medical invalidation, possible medical trauma is really important. Yeah. And do you, um, do you mostly work with, uh, medical. . Um, when you work with kids, are they mostly like medical issues or do you, is it kind of an array of Um, so currently it's a little bit more of an array, but I definitely specialize in the trauma realm.
And as we know through things like the ACEs study, a lot of health outcomes are stemming from childhood trauma, so typically goes hand in hand. Absolutely. And do you run any groups or. I don't right now. Um, I'm actually working with the executive director of our place. Um, she actually gives resources and support to those who have disabilities and who have diagnosed disabilities.
And so we've actually thrown around the idea of a group that will be wonderful long term, but currently no. Yeah. Um, that's awesome. Yeah. Well, if that ever happens, let me know. I'm happy. Send it out to the email list of people who listen to this podcast. Um, cuz groups for kids, um, especially with medical issues is, um, it would just, it goes back to that concept of play and community and support and you're not alone and all of that.
So I opportunity to actually be a child. Wild . Yeah. Yeah, exactly. Crazy. Um, well thank you so much for being here, Sarah. It was a pleasure. Um, anything, uh, any like, words of wisdom you wanna leave people before we head off today? . Um, well first of all, thank you for giving me time and space. Um, obviously this is something I feel very passionate about for my own personal and professional experiences, and I think just leaving things is you're never too much and I'm so sorry if you've ever felt like.
You, your experiences, your thoughts, your feelings are too much or like they're not enough. Um, and I think if anyone's ever felt that way, I think we all have in our own small doses or big doses, just depending. Um, you have support and there support there for you. Awesome. Thank you so much, Sarah. Thank you.
Episode Summary and Notes
Meet Sarah Erdman: a director of children and family services and an associate professional counselor with a master's degree in clinical mental health counseling from the University of Georgia. With extensive experience working with children, adolescents, families, and adults, she specializes in trauma-focused therapy. Her diverse training includes art therapy, play therapy, medical play therapy, and trauma-focused cognitive-behavioral therapy. Sarah's background in working with survivors of medical-based trauma, child abuse, domestic violence, and suicide equips her with a profound passion for helping individuals who have experienced trauma, as well as those with chronic medical conditions.
Medical Play Therapy:
Medical play therapy is a child life-based modality that Sarah has passionately integrated into clinical mental health. It offers a unique space for children to explore their health concerns and medical experiences through play. Unlike the hospital setting where time is often limited and procedures are imminent, medical play therapy allows for a more relaxed and therapeutic exploration of a child's emotions and experiences related to their medical conditions.
Sarah's Approach:
Sarah's approach to medical play therapy is deeply rooted in understanding the child's perspective. She begins by normalizing their experiences, affirming their feelings, and establishing a connection. By naming and externalizing their medical condition, children can begin to view it as something separate from themselves, reducing the burden of feeling “broken.”
Addressing Stigma and Shame:
Children dealing with chronic illnesses often face stigma, shame, and feelings of being different. Sarah's approach helps them find body neutrality, an essential step on the path to self-acceptance. She encourages them to explore what neutrality looks like in their bodies and acknowledges that it's okay not to feel positive every day. This approach is more attainable and relatable for many children, especially those navigating complex medical journeys.
Supporting Parents:
Sarah recognizes that parents of children with chronic illnesses carry their emotional burdens. They may feel guilt and shame, even though they are not at fault for their child's condition. Sarah's therapy extends to parents, providing them with guidance on how to support their children and seek their support networks. This helps bridge the gap between parents and children, fostering understanding and healing within the family unit.
Chronic Health Conditions and Long COVID:
Sarah Erdman graduated with her master's degree in 2020, coinciding with the onset of the COVID-19 pandemic. She entered the field of clinical mental health at a time when chronic health concerns, including long COVID, were on the rise. The pandemic highlighted the importance of destigmatizing chronic health conditions and providing support for those affected.
The Mental Health Aspect of Chronic Illness:
One significant challenge faced by individuals with chronic health conditions is the mental and emotional toll. The fear of disclosing symptoms due to societal stigmatization and self-doubt can exacerbate symptoms and lead to further distress. Therapy plays a crucial role in helping individuals cope with these challenges and reduce the internal shame associated with their conditions.
The Intersection of Medical Play Therapy and Trauma:
Medical play therapy provides a unique opportunity for individuals to connect with their bodies and health concerns in a therapeutic setting. It allows clients to explore their conditions, name them, and express their feelings creatively. This approach bridges the gap between medical care and emotional support, providing a more comprehensive healing experience.
The Importance of Co-Regulation:
Co-regulation is essential, particularly for parents of children with chronic health conditions. It involves parents and children sharing the experience of regulating their emotions and coping with stress together. Parents are encouraged to create a safe space where they can be honest about their feelings, helping their children understand that it's okay to talk about their experiences and emotions.
Co-Regulation with Infants:
For parents with infants who cannot communicate verbally, co-regulation relies on somatic experiences and sensory adaptations. Infants can pick up on their caregivers' emotions and bodily sensations, making it crucial for parents to manage their reactions and create a soothing environment. Gentle humming, singing, or talking can help infants feel secure and regulated.
The Multitasking Challenge:
Sarah highlights how parenthood, particularly the early stages of caring for an infant, forces parents into a continuous state of multitasking. This shift can be jarring for adults accustomed to maintaining focused attention for extended periods. She emphasizes the importance of adapting to this new reality, as it aligns more with the multitasking demands of real life.
The Impact of Early Education:
Both Sarah and her colleague acknowledge that our educational systems prioritize sustained focus and discourage distractions. However, when parenting, this model clashes with the constant need to shift attention. The panel suggests that reevaluating educational practices to include teaching adaptive multitasking skills might better prepare individuals for parenthood.
Co-Regulation and Parenting:
Sarah highlights the significance of co-regulation when parenting. Having a support system can provide much-needed relief and allow parents to focus for longer periods. She mentions that low frustration tolerance can make these interruptions particularly challenging and underscores the importance of building frustration tolerance.
The Role of Self-Regulation:
Both Sarah and her colleague agree that self-regulation is essential when navigating the demands of parenting. Parents must manage their reactions and emotions, especially when dealing with infants who cannot communicate verbally. They emphasize the value of creating a calming environment through techniques like humming or talking to the baby.
The Intersection of Mind and Body:
The conversation pivots to the intertwined relationship between the mind and body. Sarah explains that one's body often dictates their window of tolerance, affecting their ability to process thoughts and emotions. She cautions against trying to think one's way into a particular state of mind, highlighting the importance of understanding and working with the body.
Body Neutrality and Self-Care:
Sarah shares her journey with body acceptance, acknowledging that body positivity doesn't always resonate. Instead, she practices body neutrality, allowing herself to coexist with her body on days when a positive outlook feels unattainable. She prioritizes self-care rituals that honor her body, setting a positive tone for the day ahead.
Honoring the Body's Needs:
Both speakers discuss the privilege associated with their experiences and stress the importance of recognizing this privilege in their journey toward self-acceptance. Sarah emphasizes that starting the day by honoring her body through exercise or self-care rituals sets a positive tone, allowing her to better serve others throughout the day.
Conclusion:
Sarah Erdman's work in the field of medical play therapy is both innovative and transformative. By providing a safe space for children to explore their medical experiences through play, she helps them regain a sense of control, autonomy, and self-acceptance. Her approach not only supports the children but also extends to their parents, fostering a more compassionate and understanding environment within the family.
In a world where children with chronic illnesses often feel isolated and stigmatized, Sarah Erdman's dedication to medical play therapy offers hope, healing, and the opportunity to find joy in their unique journeys. Through her work, she is breaking down barriers, one play session at a time, and helping children and families thrive in the face of adversity.