I am a psychotherapist specialising in child psychology, and I have spent two decades sitting quietly before children and families whose tales made my heart clench, or whose struggles felt so confounding I wondered if anyone could truly help them. But rarely had a child so warmed my own heart as Lily, and few cases proved so resilient, healing and ultimately, profoundly inspiring. Seven-year-old Lily was a lively child with a fire in her belly and a sparkle in her green eyes. She was prone to be tumbly in the summer, and used to lie on her back gazing up at the canopy of leaves.
She was a curious girl, curious about everything. Her dad was an accomplished surgeon but, to Lily, he was simply mum’s husband, nice to be around but never to be bumped out of the way while she explored the garden with her younger brother and basket of pullet eggs. Her mum was a doctor of philosophy, and taught at a university. Lily understood their jobs, sort of, but only in general terms.
She knew that her dad stitched people back together again, and her mum taught people how to think like the pigs in George Orwell’s book, Animal Farm. Her mum wrote articles and books about literacy and learning styles and magic. Yes, magic. Once, when Lily was alone in this mum’s office, she had found a stack of papers, and on the top was typed the initial sentence of a book, its second line starting … magic.
Any child psychotherapist will tell you that the landscape of the child mind is made up of many different elements: emotions, fears and fantasy. When those forces combine, for example in the night time dreams of their nocturnal terrors, the effect on children can be devastating. What follows here is an example of this kind of struggle – the battle to overcome fears, and once again sleep peacefully, as seen in the case of Lily.
Lily’s Story: The Nightmare Begins
It was a cool autumn morning when I met Lily for the first time. She walked into my office, holding her mom’s hand and glancing anxiously around the room. Her mom, Sarah, looked tired – the sleepless nights of early parenting evident from the circles under her eyes. She started speaking, explaining what was going on.
‘It started three months ago,’ Sarah said anxiously. ‘Lily began having terrible nightmares. First, it was once or twice a week, and now it’s almost every night. She awakes screaming, drenched in sweat, and it takes several hours to calm her down.
I turned to Lily, running a finger along the toys littering my office. ‘Lily,’ I said, ‘can you tell me about these dreams that are frightening you?’
Lily’s eyes glistened with tears. ‘There are monsters,’ she said. ‘Big, huge monsters that want to kill me. They are chasing me. I can’t run away from them. I don’t want to sleep every night anymore, because they keep coming back.’
It was obvious that these nightmares had turned into a full-blown manifestation of sleepless anxiety. Lily had acquired the fear of falling asleep because perhaps one time it led to the monsters returning to her bedroom and she did not have the courage to stand up to them again. Her fear was spreading across her waking world. She was becoming increasingly fearful and worried during the day, often via distorted thoughts that led to a feeling of overwhelming anxiety and distress. This led to physical sensations such as a feeling of tension or shortness of breath, which then resulted in behaviours such as being clingy with me or breaking down into tears.
Sarah then explained how Lily’s fear of sleep had become the dominant issue in their lives. Bed-time was now a nightly battle, in which their daughter would use every trick in the book to avoid bed. She would beg for an extra story written just for herself; ask for one last drink, or simply cry her heart out. When sleep finally came, it was often hours later and then just a short, quick burst. For that reason, it was always punctuated by nightmares in which she would wake up terrified and scared, with her parents often equally as exhausted.
‘We’ve tried everything,’ her mother said at last in a voice heavy with tears. ‘Night lights, calming music, lying with her until she falls to sleep. Nothing works. We don’t know what to do. Lily clearly suffers from this, and we feel helpless. Can you help us?
As I listened to Sarah talk and watched Lily play, it struck me that this case would need to be approached delicately and sensitively – and approached on Lily’s terms. It was obvious that the recurrent bad dreams were a symptom representing underlying anxieties, and that Lily required a space in which she could safely and thoroughly explore and express these fears. I decided that the best intervention for Lily would be child-centred play therapy.
The Power of Play: Choosing Child-Centered Play Therapy
Given the importance of play in children’s lives, I recalled what the TV host Fred Rogers had said about the value of play: ‘Play is often talked about as if it were a relief from serious learning. But for children, play is serious learning.’ Child-centred play therapy represents the cornerstone of this kind of approach, and I thought it would be ideal for Lily.
This is the foundation of child-centred play therapy: play is the natural language of the child. Just like any language it enables children to express themselves – to talk, to act out, to make sense of how they feel and process their anxieties and their feelings within the framework of play within a safe and non-threatening environment. For a child such as Lily, who might find it difficult to articulate her fears, this approach to communicating with them would allow them to communicate without being asked questions.
I told Sarah that, initially, our sessions would involve allowing Lily to play freely with any toy and material my office-drawer and box of Play-Doh had to offer: I would simply observe, reflect, and step in only if necessary, never to interpret, analyse nor to direct or instruct a play, but to highlight a possible meaning Lily could be developing. However, importantly, I tried to provide Lily with a sense that she would be in control of the experience. I did this by assuring her that she could stop at any time and would be able to play in the most unhurried manner possible. My idea was to leave her in charge of how long she would be willing to confront her fears.
Sarah was skeptical at first. ‘How is that going to help with her nightmares?’ she asked. I explained that through play, Lily would have the opportunity to:
Express her fears in a safe environment
Develop a sense of mastery over her anxieties
Learn and practice coping strategies
Build self-confidence and resilience
With Sarah’s understanding and agreement, we were ready to begin Lily’s therapy journey.
The First Sessions: Building Trust and Creating a Safe Space
For the first few sessions, building trust and comfort in the therapy space with Lily was the primary goal. I took her on a tour of the playroom, explaining that this was her special time and space, as well as a place she could play with anything she liked.
The first session saw Lily cling to her mum and seemingly reluctant to play with the toys. But, after a few sessions, her curious nature began to emerge. She spent more time with the dollshouse, moving the furniture and the baby doll from one room to another.
It turned out that one particular session she turned the dollhouse into a bedtime scene where she put one of the child dolls into the bed and surrounded it with other dolls. When I asked her who they were, she responded quietly: ‘I don’t know.’
“They’re the protectors,” Lily said. “They keep the bad dreams away.”
It was a turning point. Lily was engaging with her own feelings without prompting – acting out her fears, and also her need for protection through her play: ‘The little doll feels safe with the protectors around.’
Lily nodded, adding more ‘protector’ dolls to the scene. This play sequence about fear of going to bed became both a regular script and a safe playground for her worried feelings and actions.
With each successive session, however, Lily looked more animated and confident in her play. She created lengthy narratives, involving the toys in quests of bravery to overcome fear. Perhaps most telling, there was one moment, as she dug in the sandbox to create a so-called ‘monster trap’, that broke my heart.
‘The monsters are stuck here,’ she said as she patted the sand, ‘in the sand, and the monsters can’t hurt anybody, from the sand.’ 1245 words, rhyming couplets, triple metre.148 words on a page, rhyming couplets, triple metre. 1245 words, free verse, triple metre.
This play sequence was a sign that Lily was starting to identify as the agent in her terror – she was not only the victim but also the warrior who takes up arms against the terrors of the night.
During these sessions, I reflected back what she said and did to help her identify and label her emotions. Often children can’t put words to what they are feeling and how they feel, so it’s important to help them do that. This is one of the most basic building blocks of emotional intelligence, and crucial for healthy coping.
With each session, Lily felt more comfortable in the playroom, and began to share what scared her, enabling me to add certain details to my thoughts. Again, these interventions proved perfectly timed: over the next few sessions, we’d start to address her sleep anxiety head-on and develop specific coping mechanisms so she could be safe in her room at night.