Using Superheroes in Play Therapy

family-books-superhero-leadWe all have our superheroes especially because superheroes have the ability to inspire, empower, support and occasionally save us. Sometimes, superheroes help us to save ourselves.

I have already penned some articles about the magical technique of Superhero Therapy, and how the concept of superheroes can be used in different psychotherapeutic approaches to support people who are in distress. However, that exploration was mainly about how we might use superheroes with adults in therapy.

What about using superheroes for children?

Many of the points that stand for adults are true for children. Thinking about superheroes – their lives, adventures, challenges, friends, powers and weaknesses – can provide a range of creative ways of working. This might include problem solving, being kinder to oneself, hearing stories of triumph over adversity, working out what one’s own superpowers are, and finding strength.

The narratives that children tell about superheroes might lead us to understand what they are trying to ‘work through’ (e.g. do they focus on battles, sex and sexuality, people being saved, when things go wrong, when the superhero has to lie about their true identity?). We might also wonder who the child identifies with (sidekick, superhero, police chief, villain), and whether the characters of which they speak represent either feelings, themselves, or other people in their lives.

However, one of the main differences between adult and child therapies is the difference in how playing is used as part of therapy. The organisation Play Therapy UK suggests that around 8/10 children with severe problems, such as emotional or behavioural difficulties, will show positive change after play therapeutic interventions.

Engaging in play, fantasy, and the realm of the imaginary can also make it easier to access and talk about difficult topics. In some ways, this may particularly true for younger people who don’t have the words, experience and knowledge to talk about things directly. Although, being an adult and having more experience is no guarantee that it will be easier to talk about things. Roleplays could be used to help children and their families take different perspectives, and understand each other differently.

Psychodynamic play therapy may simply be allowing a child to play with anything from a box of toys. This could (and probably should) include characters such as superheroes. Commenting on how the child chooses to play, without the therapist actively directing their play, can lead to useful insights about a child’s wellbeing due to the themes and ideas that occur during such play.

Children and young people may also use sandplay – arranging toys and items within the confines of a sandbox, to represent their inner states of mind. The work of Dora Kalff is cited in both the American and British-Irish sandplay organisations – her work is based on Jungian principles that the unconscious will guide the play. Of course, this is not restricted to children and young people, but sandplay is certainly a useful way to reach children particularly.

Filial therapy is one branch of play therapy, which focuses on the relationships. Parents (or caregivers) are seen as the main agents of change, and the sessions are often led by them. The therapist supports the parent in using skills that are similar to nondirective play therapy. The scope for using superheroes here is huge. Superhero narratives can support parents to understand and frame their children’s feelings, or it may be a way for parents and children to find something that they have in common. Using superhero-based toys may also open up a range of potential narratives to parent and child, as described above.

Theraplay®, another type of play work with children, “is a child and family therapy for building and enhancing attachment, self-esteem, trust in others, and joyful engagement”. Play tasks have particular aims, and they are designed to develop particular skillsets whilst being fun for all. Theraplay® involves children playing games – with their families – which tap into challenge, structure, shared engagement and nurturing. Children’s favourite superheroes could be incorporated into how the tasks are explained to the child, or superhero-themed items such as soft toys, bubbles etc. could be used as part of the play.

Attachment-Based Play Therapy (ABPT) is a different (less researched) approach, which focuses on teaching children how to feel and experience emotion. It suggests that children should learn how to be accepting of feelings, become able to ‘attach’ to themselves, and take care of themselves from a position of compassion and kindness. In this way, superheroes could be used during play to teach a child how to express and accept their feelings. Examples could be drawn from how superheroes look after themselves, or what the person would say to their favourite hero if that person was sad or distressed.

In conclusion, superheroes have an important place in work with children and young people. Superheroes can fit pretty much anywhere depending on the person and the therapist. For younger people, superheroes can particularly serve to be role models, relatable characters, characters through which a young person can parallel their own experiences, and of course a way to build a rapport with their therapist. With these insights, perhaps more of us can go forth and prosper with the youngsters with whom we work.

How X-Men Helped Me Overcome PTSD

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“What wouldn’t I give to be normal!” -Mystique in X-Men First Class

I grew up on fiction. It was brain food to me. I generally preferred to read books to just about any other activity. Over the past few years I’ve been incorporating fictional characters into Superhero Therapy. For me these characters hold a deep and personal meaning, after all, some of them actually helped me recover from my own traumatic history.

On April 26, 1986, there was an explosion at the Chernobyl Nuclear Power Plant, located in Ukraine. I was just a few months short of 3 and was only a few towns away. The people in Ukraine didn’t know about the disaster, or at the very least about the extent of it.

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This is my first memory. I remember some parts of it quite vividly while others were filled in by my parents. It was May Day, which is a big holiday in Ukraine, where I was born and raised. My parents and I were marching in the parade along with hundreds of other people. I was sitting on my father’s shoulders and holding a red balloon. The music was playing and despite being overwhelmed by the amount of people present there, I was excited.

To my left there was a scream.

Someone, I think it might have been a woman, was convulsing on the ground. Some people ran to call the paramedics.

Then other people started to fall down. Some were bleeding from their noses.

My father kept me on his shoulders and he and my mother ran all the way home. It wasn’t until some time later that we found out about the extent of the explosion and the amount of radiation spilled. Until then, completely unaware, we continued drinking the water from the faucet, going outside, and eating fresh fruits and vegetables. All of these were poisoned.

When the news broke, we were all encouraged to seek medical attention and underwent iodine treatments. Still, many people suffered from some kind of physical (and many also psychological) illnesses as a result. For me, I started having frequent nosebleeds that wouldn’t clot for a long time and severe migraines.

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Dr. Janina Scarlet

My migraines were especially intrusive. There was one time, it might have been when I was around 7 or 8, I was in so much pain that a blood vessel in my eye popped. On other occasions my migraines would lead to seizures.

My migraines seemed to be triggered by weather and environmental changes. When the barometric pressure would drop (before it rains) and also when there would be radiation changes in the atmosphere (such as solar flares, for example), that was when I was most likely to experience these symptoms.

I also started having nightmares and was too afraid to sleep without a light on. For many years after that incident I was really nervous about being in large crowds, and did not want to talk about anything related to Chernobyl (I still struggle with this last one to this day). I obviously didn’t know it back then, but I was struggling with PTSD.

Things got worse when my family and I first moved to the United States. I was in 7th grade, did not speak English too well, and most people my age did not have a good understanding of what radiation poisoning was nor what a seizure disorder was. On a couple of occasions I would overhear people cautioning one another not to touch me because I might be “radioactive.”

Feeling extremely lonely and not having any friends for an extended period of time I started to feel depressed. I avoided people for the fear that they would make fun of me or would judge me. During a parent-teacher conference, my homeroom teacher told my mother that I was a good student but that she couldn’t figure out why I always looked so sad. When my mother asked me about it, I shrugged it off. How could I tell her that I felt like a freak?

For years I felt alone and ashamed, and even disgusted with my physical and emotional experiences. There were times when I just wanted to die.

Until I saw the first X-Men movie.

I didn’t know much about the X-Men when I went to see it but from the moment I realized that they were mutants, I was hooked. These incredible people all had some kind of a genetic mutation, some of them due to radiation exposure, just like me. And somehow realizing that I was not alone, even if the people I was relating to were fictional, for the first time in many years helped me feel connected…helped me feel…normal.

The character I especially connected to was Storm because she could control the weather (how cool is that?)!

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The more I found out about Storm, the more I identified with her. Storm (real name: Ororo Munroe) also had a childhood trauma history. When she was 6 years old, her parents were crushed to death by a fallen plane. Ororo barely made it out alive. After that Ororo became claustrophobic (having an intense fear of tight spaces), which persisted even after she had joined the X-Men.

Storm’s powers come from her connection with the Earth and her emotions allow her to influence the weather. Somehow learning this made me rethink my own symptoms as my own special way of connecting with the Earth, like Storm. I feel when the Earth changes and when the weather changes. This reframe allowed me to view my symptoms as a kind of Superpower. And somehow, in this process my symptoms began to change. I still have them but they no longer stop me from doing what is truly important to me. I’ve made space for these symptoms and they made space for me.

And somehow from this adventure, Superhero Therapy was born. After having spoken to many people, having heard so many stories, I am convinced that if we connect to someone, be it real or fictional, we just might find the very kind of strength and inspiration that we need to recover.

How Mental Health and Pop Culture Can Partner for Good

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Los Angeles, CA – For the first time, the psychiatrists of Broadcast Thought, H. Eric Bender, M.D., Praveen R. Kambam, M.D., and Vasilis K. Pozios, M.D., will bring their unique expertise in mental health and pop culture to New York Comic Con for a fun and informative panel!

On Sunday, October 11, 2015, from 4:00 pm to 5:00 pm in Room 1A24, Broadcast Thought will be joined by a team of entertainment and mental health professionals to present “A Force for Good: The Powerful Partnership Between Mental Health and Pop Culture.”

Awareness of pop culture’s power to help people with mental illnesses is reaching new heights, from celebrated depictions of superhero struggles to the personal stories of creators themselves.

  • Actress and writer Mara Wilson (Mrs. Doubtfire, Matilda, Welcome to Night Vale, What Are You Afraid Of?) will share her personal struggles with anxiety and depression and how her experiences have shaped her career.
  • Eisner-nominated writer Alex de Campi (Smoke/Ashes, No Mercy, Grindhouse) will talk about the creator and mental illness, as well as treating mental illness respectfully in fiction.
  • Comedian Jenny Jaffe (Camp Time with Jenny Jaffe, CollegeHumor) will discuss her outreach to teens and young adults through her innovative mental health nonprofit, Project UROK.
  • Psychologist Janina Scarlet, Ph.D., (Superhero Therapy) will share moving stories of patients inspired by accurate comic book depictions of mental disorders in their recovery from mental illnesses.
  • Forensic psychiatrist Vasilis K. Pozios, M.D., (Broadcast Thought) will discuss Aura, his PRISM Award-winning short story about a stigmatized superhero with bipolar disorder, published in Rise: Comics Against Bullying #2 from Northwest Press.
  • Forensic psychiatrists H. Eric Bender, M.D., and Praveen R. Kambam, M.D., (Broadcast Thought) will discuss why accurate mental health depictions matter and how less stigmatizing — and more creative — representations can benefit patients and publishers alike.

Attorney Jeff Trexler (The Beat, The Comics Journal) will moderate, highlighting how entertainment can be a force for good in mental health and why more accurate and less stigmatizing mental health representations are a “win-win” for media outlets and people with mental illnesses alike.

About Broadcast Thought:

Broadcast Thought is a creative collective of three psychiatric physicians, H. Eric Bender, M.D., Praveen R. Kambam, M.D., and Vasilis K. Pozios, M.D., whose goals include shifting the paradigm of how the media and entertainment industries portray mental health issues. The doctors serve as creative consultants and subject matter experts to the media and entertainment industries and co-create mental health-related content. They are freelance contributors to The New York Times, Wired, and The Walking Dead: The Official Magazine, and they have been featured in Time, The Huffington Post, ABC News, Entertainment Weekly, and Discover.

*Editor’s note: Social Work Helper will be covering this panel and others at New York Comic Con 2015. For behind the scenes interviews and access, follow Social Work Helper on Periscope and on twitter at @swhelpercom.

What is Superhero Therapy?

Superman-couch

Did you ever want to be a Superhero? Did you ever wish that you could possess magical powers, like Harry Potter, or travel around the world in a time machine, called the T.A.R.D.I.S. with an alien who calls himself The Doctor? What if you could, in a way?

Many of us wish we had some kind of magical or extraordinary abilities, and many of us strongly identify with fictional characters, like Batman, Superman, Buffy the Vampire Slayer, characters from Harry Potter, Firefly, and many others. Recent research findings suggest that identifying with fictional characters can actually be extremely beneficial as it can teach us empathy, remind us that we are not alone in our painful experience, inspire us to eat healthier, and allow us to better cope with difficult life transitions.

The goal of Superhero Therapy, therefore, is to help patients who identify with a particular fictional character to use that relationship with that character in order to identify and process their own experiences and feelings, as well as to encourage them to make meaningful changes in their lives. Thus, the goal of Superhero Therapy is to teach us how to become the very magical Superhero-Jedi that we need in order to become the very best versions of ourselves. Superhero Therapy refers to using examples of Superheroes, as well as characters from fantasy and science fiction in research supported therapy, such as cognitive behavioral therapy (CBT) and acceptance and commitment therapy (ACT).

Why Superhero Therapy?

Many people have a hard time identifying their own thoughts and emotions, either because it’s too painful, or they’ve never thought about it. I see many patients with posttraumatic stress disorder (PTSD), including active duty service members, Veterans, and non-military civilians. I find that a lot of the time when I ask my patients how they felt at the time of the traumatic event, or even about which emotions they are experiencing in the present moment, many state that they aren’t sure or do not wish to answer.

However, discussing how a specific character felt at a given moment can be helpful in understanding our own emotions. For example, in the Defense Department’s recent efforts to assist Veterans with PTSD, they’ve contracted an independent company, Theater of War, to put on theatre plays for Veterans with combat-related themes, based on Ancient Greek plays. One of these plays, Ajax, for example, tells a story about a character struggling with his symptoms after the war and eventually committing suicide. Veterans and their spouses who saw the play reported that the play helped them understand their own emotions by relating to the characters. One Veteran in particular was moved by the play, stating: “I’ve been Ajax. I’ve spoken to Ajax.”

Talking about fictional characters’ emotional experiences might seem safer than talking about our own, so with my patients, that is where we often start, later drawing parallels to their own feelings and subsequently switching over to focusing on those. For instance, many service members and Veterans I’ve worked with strongly identify with Superheroes, in particular, Batman, Superman, and The Hulk. Let’s take a look at Superman.

Superman (real name Kal-El) is a comic book character who is an alien from another planet, Krypton, who was sent to Earth as a child. His Earth name is Clark Kent, and while in the Solar System, including Planet Earth, he appears to have superhuman abilities: he possesses super strength, super speed, he can fly, he can fight, he has X-ray vision, and many other cool powers. It is no surprise that Superman is a role model to many service members and Veterans, who believe him to be invincible. The phrase or a variation of the phrase I often hear in this population is “I wanted to be Superman… I failed.” This is a common response many people have, harshly judging their own experiences of having PTSD. This is a common dialogue I’ve engaged in with many of my patients:

Patient: “I just feel like such a failure.”

Therapist: “What makes you say that?”

Patient: “I wanted to be like Superman, you know? Strong.”

Therapist: “And now you don’t feel that way?”

Patient: “No, I have PTSD.”

Therapist: “And what does that mean about you?”

Patient: “It means that I’m weak.”

Therapist: “Wow, that’s harsh. Let me ask you this, did Superman have any vulnerabilities?”

Patient: “No.”

Therapist: “No?”

Patient: “Well, there’s Kryptonite…”

Therapist: “Right. What is it and what does it do?”

Patient: “Kryptonite is this radioactive material from Krypton, where Superman was born. It takes away his powers and can kill him.”

Therapist: “So Kryptonite makes him vulnerable?”

Patient: “Yes.”

Therapist: “And does this make him any less of a Superhero?”

Patient: “No, of course not… Oh, I see what you mean, that having PTSD doesn’t mean I’m not Superman.”

This is an example of how cognitive behavioral therapy (CBT) could look when using Superhero examples in session. CBT is a type of therapy that looks at the relationship between thoughts, feelings, and behaviors, which are bidirectional, meaning that they affect one another. In the example above, the patient’s thought: “because I have PTSD, that means I’m weak, and I failed in being Superman” is affecting his feelings (making him feel more depressed) and is affecting his behavior (for example, not wanting to socialize with others).

Some of the thoughts we have might not be 100% accurate, often leading to some painful emotions, and maladaptive behaviors. By challenging the validity of the thoughts (testing to see whether or not the thought is accurate), we can get out of the maladaptive loop. A CBT therapist’s job is to teach a patient how to implement the skill of challenging their own thoughts, to change the maladaptive behaviors in order to help the patient recover, as well as become their own therapist, to be able to help themselves in the future.

The other type of therapy that lends itself nicely to Superhero Therapy is acceptance and commitment therapy (ACT). I often describe it as Superhero Training, as ACT teaches us to become the very Superhero (or witch/wizard, vampire slayer, Jedi, or any other title that seems most helpful) that we wish to be by following our values, (the most important things to us, like family, friends, creativity, altruism, spirituality, and others), and by facing whatever dragons show up along the way (thoughts, feelings, personal stories we tell ourselves, such as “I’m a failure” or “I’m not good enough”) and practicing the Jedi-like skill of mindfulness.

Let’s take a look at how Harry Potter can be used in therapy to teach us some of these skills. Briefly, Harry Potter is a young wizard in training, whose parents were killed by Lord Voldemort, an evil wizard. Harry and his friends, Ron and Hermione, are studying magic at Hogwarts School of Witchcraft and Wizardry. When Lord Voldemort and his followers, the Death Eaters, start to come back to power, aiming to exterminate all non-magical humans (called Muggles), as well as all Muggle-born witches and wizards, it is up to Harry and his friends to stop them.

In the first book of the Harry Potter series, Harry, Ron, and Hermione find out that Lord Voldemort is attempting to come to power by trying to steal the Philosopher’s Stone, which grants immortality to its owner. In trying to stop him, Harry and his friends have to undergo a series of dangerous tests. One of them, the Devil’s Snare, is a magical plant that uses its tentacle-like branches to suffocate the person that touches it.

The Devil’s Snare presents a great ACT metaphor of acceptance and experiential avoidance: the plant seems to respond to tension levels, the more one struggles with it, the tighter its grip and the more likely it is to choke them. This is experiential avoidance, trying to escape the present experience, and just like the Devil’s Snare, in most cases, the more we try to escape, the deeper our struggle becomes. However, if we stop struggling and are willing to experience this discomfort (acceptance), then we are more likely to survive – when Hermione lets go of the struggle with the plant, for example, the Devil’s Snare releases her.

Here is how Superhero Therapy using ACT can look in a clinical setting. One of my clients was struggling with panic disorder and was too scared to go to places where a panic attack might take place and where escape might be difficult (this is called agoraphobia). The patient (let’s call her “Lucy”) stated that as a result of her fears of getting additional panic attacks she had to drop out of college, move back in with her parents, was unable to spend time with her friends, was unable to volunteer in a community theatre, which was something she really enjoyed, and essentially put her life on hold. While she did not have many panic attacks when staying at home, Lucy’s life became constricted, based solely around her anxiety disorder. Lucy stated that she would not be willing to go to unfamiliar places until her panic attacks went away completely and she was absolutely sure that they would not happen again. Her thoughts, such as “if I go out, I will have a panic attack” and “I’m weak” prevented her from living the kind of life she wanted.

In our sessions together we talked about the Harry Potter series; her favorite character was Harry’s friend, Ron Weasley. She said that she identified with Ron because of his fear of spiders. While Lucy herself did not have a fear of spiders, she stated that she could relate to Ron because “he knows what it’s like to be really scared, he gets so overwhelmed by spiders that he can’t even move. That’s exactly how I feel.”

In discussing Ron in therapy, Lucy was able to identify that as scared as Ron was of the spiders, when it was really important, specifically, when Hermione was Petrified (turned to stone) by an unknown monster in Harry Potter and the Chamber of Secrets, Ron (as well as Harry) followed the spiders into the Forbidden Forest in order to get the information needed to save Hermione and other Petrified students. This is a great example of the ACT concept of values. No one who read the books can deny that Ron was terrified when he followed and interacted with the spiders. He was probably also doubting his own abilities and might have had many insecure thoughts, such as “I will fail,” or “I’m not good enough,” or maybe even “I’m a coward.” And yet, despite his fear he was able to follow through, he was willing to experience whatever terrifying emotions and thoughts showed up in order to save his friend, showing true courage and heroism.

I will never forget the first time that Lucy and I drove around her block as a part of her facing her fears. She was trembling and was saying that she did not think that she could do it. However, she got behind the wheel, tightened her Gryffindor scarf, and turned on the engine. It took less than 5 minutes to go around the block and when we were finished Lucy was ecstatic. She was in tears, she was laughing, and saying, “I can’t believe I just did that!”

Lucy and I continued working on taking “superhero steps” in her valued direction and practiced driving to a movie theatre and other locations. Lucy still gets anxious sometimes but just like a true Superhero that she is, she courageously goes out with her friends, she’s back in school, and has even traveled abroad with her family.

I always say that the bravest people I know are my patients. It takes a lot of courage to experience overwhelming, and at times, incapacitating, anxiety, to come to treatment, and to face our fears. Many people believe that fear is bad, something that needs to go away for us to live a normal life. However, fear can actually be quite advantageous. In a recent Doctor Who episode, Listen, we learn that fear can be a Superpower. Doctor Who is a British science fiction TV show about an alien, who calls himself The Doctor. The Doctor travels around the universe in a time machine, called the T.A.R.D.I.S. (which stands for Time and Relative Dimension in Space) and saves those in need.

The Doctor is over 2,000 years old, and seems to know a thing or two about fear. His take is this: Fear is a Superpower. Fear causes the release of adrenaline, which makes us think faster and fight harder, suggesting that we don’t need to run away from fear, fear might actually be helpful.

The bottom line is that running away from fear and not living our lives according to our values isn’t helpful, whereas learning how to face our fears in the service of what’s most important to us, that’s what being a Superhero is all about.

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