The Power of Metaphor.

What is a metaphor, is it something that is provided to make things up, to avoid talking about worries or concerns, can a metaphor really open up a time and space where exploration of emotions can happen?

Metaphor can be  a word or phrase that is used to describe a object or an action, an emblem, to paint a picture or create an image.
Some children and young people use the work of metaphor as it offers a visual description of a thought, feeling or action- with the focus being shifted away from talking about deep feelings, or events that have impacted their lives.

When I started working alongside children and young people using metaphor  felt clumsy at times, I struggled with finding the right language and when I did, my responses felt like I had adopted some new dialect that only made sense to me, so it took a lot of practise, reading, learning and observing others using metaphor to find its natural place in my work,  to the support I can offer children, and young people coming into hospital and those living with a long term and life changing health condition.

Using the medium of play and specialised distraction with children and young people lays a platform for using different techniques and skills, it is something that requires training, and mentoring, and time.

Working in metaphor using play gives children and young people the space and tool to create and work through an unknown thought,  using metaphor allows them to name the thought, then it can be explored, it can be felt, and it can be held safely, and acknowledged.

Often children and young people store and bury feelings that are so powerful, they just don't know what to do, what to say or how to be.

Spending time with children and young people allows you to gain a snap shot of their lives, and if they give permission and invite you in, play and metaphor is a powerful tool and skill to have, but as always the right level of training and practise - and care should be gained first, this is a skill that requires specific training, working in metaphor is powerful and shouldn't be under estimated.

Children and young people use metaphor a great deal when trying to describe an event or emotion that is just too painful to say out loud, using metaphor removes the attention from them, and allows them to communicate in another way.

Here are some examples.

" Its like this you see, a straw works really well with water, but if you put it in milkshake or it gets blocked, nothing moves, and when the straw is used, nothing happens, everything is blocked, full up, doesn't work"

An example of a description from a child who tried everything to tell others that she was sad and anxious and worried - but she just couldn't find the words, she was fed up and she was too full up of worry and uncertainty, why does the bad thing happen to me.

"There was this thing and it had fallen out of a suitcase, it tried so hard to get back in but the suitcase was so full up and heavy that it just couldn't find a place to hide anymore"

"There was a spaceman and he was attached to the rocket by a long elastic band, one night while he was out exploring space, the elastic band snapped, and he floated away from the rocket, and he just kept floating and floating, lost, and alone"

A young person full up with hospital appointments, so many that her life consisted of nothing else.

Using specialised play opportunities allows the child or young person the option of sharing in a way where the attention isn't solely on them- they feel slightly removed, but if metaphor is introduced - exploration and testing of the waters takes place- as a practitioner my role is to hold and keep safe the experience and narrative, offering creative resources to enhance the experience how ever tricky that might be.

Weather and the range of powers it has is often used as a metaphor to describe the inner fear and upset being experienced, and the pressure of keeping everything alive.

Further Reading

• Creative Metaphors of life experiences seen in Play Therapy www.counselling.org
• Using therapy stories and Metaphor in child and family treatment www.lianalowenstein.com
• Using storytelling as a therapeutic tool with children - By Margot Sunderland

Training and courses

There are many places to undertake further study and training, I have done the bulk of mine here.

Centre for Child Mental Heath- www.childmentalhealthcentre.org

@CCMH_London

Sian Spencer-Little

Copyright 2016.

Words and Time.

" Thank you so much, you really put his mind at rest, he now understands"

Time taken and given to C&YP in hospital is a rare commodity, I say this as in an ever changing and fast paced environment such as acute inpatient care- I believe it is, this is not to single out an individual , or team but an observation.

I have heard such conversations, they wished there was a little more time, to explain, adjust, prepare themselves as HCP's as well as their patients and families.
This is not always possible- what if it presents as an emergency?

I feel like I want to turn this on its head a little, so stay with me on this!

As a Specialised Play Practitioner I observe the impact a hospital admission or procedure has on C&YP when it is an acute admission or procedure.
All of a sudden they are informed that a procedure, operation or blood test needs to happen.
At that very moment- everything changes for them, their families and the HCP's caring for them.

As HCP's we don't always know significant history in terms of previous experience or trauma.

However I observe the fear, the apprehension,  I listen to the questions, the slight adjustment in level of voices, pitch, volume- I watch intently to the change in size of their pupil reaction, the flushed colour in their cheeks, the silence that takes over them.
The body language, the breathing rate.

All this occurs immediately after they are told about the procedure- I call this the "golden 5 minutes"- in this time, whilst the HCP's are preparing themselves, as they too experience all or some of the above-the C&YP needs preparing- so how we manage this next episode of care is crucial for us as practitioners, and for the child or young person.

Simple language to explain "what happens next"
Words are so very important at this stage- how we describe things, there are some words that we should not use.

Key words are the only thing parents and C&YP remember, I discussed this during the week with a family, they shared with me  " tube" " mask"  " blood"  " prick" being the most they remember in times of fear.

Tube, Mask, Blood, Prick.

This was a child who will have to come into hospital on a regular basis, for the rest of his life, and these are the words he will remember each time he prepares to visit the hospital.

What if words are not the medium- Photographs, drawings, signs, PECS (picture exchange communication system), Makaton , BSL and so on.

The "golden 5 minutes" should be for the need to know now information.
Why, What, When, How.

These are ideas, and a continual work in progress- because they can and should be adapted to each individual healthcare setting, and individual child or young person.
I should also say that I do observe, HCP's taking the time - and the results speak for themselves.

Change in practise, communication and preparation is always an adventure- it asks us to think differently, use words and language we may not have previously used ,or indeed how we would choose to describe events or actions, at times we might feel silly or self conscious, but we as adults can process that- C&YP cannot when fear and trauma takes over.

Recall what I said about turning this subject on its head........................ what would the outcomes be?

If we have a "golden 5 minutes" just imagine what impact that would have in "time" spent calming a child or young person down, when they refuse to allow HCP's to carry out observations, procedures, examinations?
Time spent encouraging a child to allow that process to happen.



If the "time" was there to prepare as HCP's then it should be there for the C&YP?
Health Play Specialists, Play Specialists, Play workers can be the time keepers.
We are also really good at sharing our skills and knowledge with the wider MDT.

 Trauma in Children is a deep and ever evolving study and research experience, - when we meet C&YP and their families for the first time we do not know what trauma, if any they have experienced, or the family history, but research and studies show us that it impacts on their very being, and ability to cope with new experiences, and how we draw on those, the fight or flight we display.

There are many battles that our patients may have fought and won, there are also many that they are still fighting and living with on a daily and hourly basis when they reach us.

Play4C&YP will be taking a few weeks break, to recharge, to reconnect, and to read!
Recommended read................
Waking the Tiger= Healing Trauma
Peter A. Levine


Sian Spencer-Little