The utilization of eye movement desensitization and reprocessing (EMDR) therapy alone, as Francine Shapiro has discussed, presents challenges when working with children, particularly with complex relational trauma. Limits for the effectiveness of EMDR include the developmental immaturity of the child and missing adaptive information, the impact of trauma on skill development, and lack of trust due to the impact of relational trauma. This chapter explores how creative arts therapy holds the potential as a special form of mentalization therapy that can support and strengthen the skills required for success in EMDR in Phase 4 processing. This approach emphasizes how the expressive arts, when used strategically, can extend the reach of EMDR by utilizing the indirect dyadic process of art making within a therapeutic relationship increasing trust, building metacognitive functioning, elevating concrete thinking through experiential learning, and taking a curious, open, and playful stance that helps grow self-reflective capacity.

This chapter provides a brief description about the intervention that was designed to support and assist children and adolescents in developing negative cognition and positive cognition in the assessment, desensitization, and installation phases using a creative intervention of “making lemonade” and turning “sour” thoughts into “sweet” thoughts. This intervention integrates eye movement desensitization and reprocessing (EMDR) and play in the processing of traumatic material. Creativity and modifications to the standard EMDR protocol have been used to great success by the leading child and adolescent therapists in the field. Lemon Squeezies is a modification of the standard EMDR protocol in the assessment, desensitization, and installation phases when working with children and adolescents. Modifications to the EMDR standard protocol should only be made to accommodate the developmental needs of each age group. If the child or adolescent does not like lemonade, the therapist may substitute another metaphor using their best clinical judgment.

This chapter reviews how clinicians can combine play therapy skills with eye movement desensitization and reprocessing (EMDR) therapy to treat young children who have experienced trauma. It presents a descriptive approach to integrating play therapy skills with the EMDR protocol for therapists already using play to facilitate trauma. Young children's trauma often arises from early neglect and abuse, resulting in emotional dysregulation and inappropriate behaviors. Child-centered play therapy, developmental play therapy, and EMDR are interventions that address these issues and are also effective relational therapies that can be even more powerful when combined. These therapies complement each other to allow successful treatment of complex trauma in our youngest clients. Through examples and a case study, therapists will appreciate how play therapy and EMDR work well together and how clinicians' play therapy skills can be easily incorporated into all phases of the EMDR protocol.

This chapter proposes the Pocket Smock as a Phase 2 intervention to facilitate the preparation process. The Pocket Smock is designed to be a visible and even tangible location to consolidate the child's acquired self-regulation resources. While it primarily serves to prepare the child for the trauma-resolution phases of the eye movement desensitization and reprocessing (EMDR) protocol, the Pocket Smock is suitable for use throughout the entire treatment process and beyond. The chapter introduces writing and coloring utensils; clothing items for smocks; preferred craft items; index cards; pocket smock template; office posters (step-by-step instructions in this chapter); optional: electronic drafting applications, camera, and Velcro dots.

Despite the potential benefits, children are often very reluctant to participate in eye movement desensitization and reprocessing (EMDR) therapy. Prescriptive play therapy for trauma involves a phase-based approach where the activities within the playroom may vary from less directive to more directive with the goal of supporting trauma exposure/trauma narrative work. Trauma-informed prescriptive play therapists guide play in the avenues that will support trauma digestion and emotional regulation. Integrating play therapy within Francine Shapiro's adaptive information processing model with a flexible approach to the EMDR protocol holds promise in using play to enter the memory network and promote healing. This chapter establishes eight essential considerations in fully integrating EMDR in a play therapy setting and examines the idea that play may be the preferred avenue to access and reprocess with EMDR the implicit memories involved so often in complex trauma in children.

TraumaPlay is a flexible, sequential, play therapy model designed for treating traumatized and attachment-disturbed children and teens. An integration of TraumaPlay and eye movement desensitization and reprocessing (EMDR) functions as a one–two power punch combination as the power of play is recognized as the child's most natural form of adaptive information processing and encourages the full-body somatic experiencing of new neurophysiological states while desensitizing and reprocessing hard things. The overarching goals of TraumaPlay include leaching the emotional toxicity out of clients' traumatic experiences, creating a more coherent narrative of these life events, and deepening relational resources. Getting through the child client's layers of protection requires developmental sensitivity, titration, and creativity. Unlocking a traumatized child's healing may take more than one key, so pairing TraumaPlay and EMDR together can maximize the effectiveness of each. TraumaPlay therapists enhance safety and security through both nondirective play therapy methods and directive play therapy interventions.

In the three decades since Francine Shapiro introduced the model, adaptive information processing (AIP) and eye movement desensitization and reprocessing (EMDR) have provided mental health clinicians with a method for conceptualizing clients' responses to traumas as adaptive and protective without diminishing the pain that comes from holding stored trauma. For those working with child clients, the goal of healing emotional and relational wounds becomes substantially more attainable when caregivers also come to view children's trauma responses as adaptive and protective, all the while developing increasing capacity for being with their children's woundedness. EMDR therapists who provide family-based play therapy need ways to establish and monitor safety within family systems in order for the integration of these modalities to offer their full power. This chapter aims to offer sandtray as a modality that allows for this integration. Sandtray offers a common language for all who engage.

This chapter addresses combining synergetic play therapy (SPT) with eye movement desensitization and reprocessing (EMDR) while maintaining fidelity to both therapies. Both SPT and EMDR are informed by the adaptive information processing (AIP) model as developed by Francine Shapiro in 1987. This combined process of therapy is synergetic and relies heavily on theories and research regarding the storage of memory, the mirror neuron system, neurobiology of the brain, interpersonal neurobiology and coregulation, and the innate states of nervous system activation. The chapter expands on these key concepts: understanding the neurobiology of coregulation as it relates to EMDR therapy and synergetic play through the lens of SPT; the importance of therapist regulation while facilitating EMDR in the playroom using SPT theory and its base in neuroscience; the stages of EMDR therapy with SPT and EMDR combined; and the use of EMDR as a directive and nondirective process in play therapy.

This chapter serves as a call to include interventions that acknowledge, value, and celebrate the culture of children and their families. The Latinx population is growing in the United States, and it is imperative that therapists provide culturally sensitive services to this population. The chapter presents playful and creative interventions that have been helpful during the different phases of eye movement desensitization and reprocessing (EMDR) therapy with Latinx children. It highlights important cultural and clinical considerations when utilizing EMDR therapy with Latinx children and teens through the lenses of three main principles: (a) Follow the child's lead and interest; (b) be curious, ask questions, and maintain an open attitude; and (c) utilize and emphasize cultural and individual strengths. It includes playful and creative interventions that have been helpful during the different phases of EMDR therapy with this population in order to make their treatment more culturally attuned and developmentally appropriate.

When children are exposed to toxic environments for many years of their childhood, they may have a difficult time even imagining a calm or safe place. Fort Tent has been adapted from Francine Shapiro's Calm Place exercise. This adaptation is designed to better suit children's needs. Abused and neglected children have very few internal and external resources to enhance the original Calm Place. The initial goal of this intervention is to create a specific experience of a Calm Place. The Fort Tent Calm/Safe Place (Fort Tent) is an intervention designed to help create safety within the constructs of the therapy office. This creative intervention heightens present moment experience of safety in real time. The Fort Tent allows clients who need a more concrete, kinesthetic intervention to be involved in the development of the safe place, thus empowering them to have a level of control in their own sense of safety.