Rooted in Relationship: Why Neuroaffirming Care Comes Before Neuro-Informed Strategy by Kimberly Bartlett, LICSW, LCSW, RPT-S™ The growing awareness of neurodiversity has brought many valuable conversations into therapeutic spaces. As more professionals and caregivers begin to recognize the broad range of neurodevelopmental experiences—Autism, ADHD, sensory differences, learning disabilities—terms like neuro-informed and neuroaffirming are becoming more common. But while the language is evolving, we must be intentional in how we embody these approaches in our work with children. In my practice as a therapist for neurodivergent children, I ground all care in a neuroaffirming philosophy first. This means that before we discuss supports, goals, or adaptations, we focus on building something far more essential: emotional safety, belonging, and unconditional acceptance. Only once these are firmly in place do I consider integrating elements of neuro-informed care—such as strategies or supports tailored to the child’s unique nervous system. Neuroaffirming vs. Neuro-Informed: A Sequence That Matters It’s important to understand that neuroaffirming care is not the same as neuro-informed care, and the order in which they are used matters greatly. Neuroaffirming care says: “You are inherently worthy and welcome as you are.” It centers the child’s right to exist and relate to the world in ways that may not fit neurotypical norms. This care resists the impulse to change or correct and instead seeks to understand and celebrate the child’s authentic ways of being. Neuro-informed care, on the other hand, incorporates specialized knowledge about how neurodivergent brains process information, respond to sensory input, and regulate emotions. It includes evidence-based supports that can be incredibly helpful—but only when applied through a lens of respect, choice, and relational attunement. There are also many instances that children are not positioned to benefit from neuro-informed strategies that seek to directly adjust their current experiences. There are alternatives to supporting these individuals when that is the case that is equally worthy and differently beneficial. In other words, being neuro-informed without being neuroaffirming can risk slipping back into compliance-based or deficit-framed approaches. That’s why neuro-informed strategies must come second—not as a first intervention, but as a response to what the child needs, once we’ve truly gotten to know them and only when they can benefit from them. My role as a therapist is to assess and guide families around these recommendations. First: Create Safety, Trust, and Attunement When a child enters therapy, especially a child who is neurodivergent, they often carry a history of feeling misunderstood, pressured to mask, or expected to behave in ways that are deeply uncomfortable or unsustainable. My first responsibility is to create a space where the child feels safe to exist without needing to perform or please. As a Registered Play Therapist – Supervisor™ I use my therapeutic playroom to help create a physical space that can uniquely support neurodivergent children and youth. Neuroaffirming care moves from understanding to honoring. It centers the inherent value of neurodivergent experiences and identities. Rather than assuming a child must be “taught” to behave neurotypically to succeed, neuroaffirming care asks: What does this child need to feel safe, understood, and accepted? How can I support this child’s self-expression and autonomy? What environmental or relational shifts could make this space more accommodating to their way of being? In my practice as a Registered Play Therapist – Supervisor™ I incorporate this approach by means of: Letting the child lead where possible—through play, special interests, or quiet connection. Matching the child’s pace for connection. Respecting and accommodating a child’s communication preferences, sensory needs, and pacing. We build a relationship rooted in attunement, consent, and mutual curiosity. Only then can we begin to explore whether specific supports or strategies might enhance their daily experiences—not to “fix” who they are, but to help them navigate a world that isn’t always designed for them. Then: Integrate Neuro-Informed Supports—Collaboratively Once a child has developed a trusting relationship with me—and once I’ve gained a deep, holistic understanding of their nervous system through observation, relational assessment, and caregiver input—neuro-informed strategies can be thoughtfully introduced. This might include: Co-regulation tools that align with the child’s sensory profile. Communication supports tailored to expressive or receptive needs. Structured routines or visual systems that reduce overwhelm. Collaborative problem-solving with caregivers to reduce stressors. Importantly, these supports are never imposed as requirements for acceptance. Instead, they’re offered as invitations—tools the child can try, adapt, or decline, based on what helps them feel more empowered and connected. Development Follows Safety This framework is grounded in a simple but powerful truth: development unfolds in the presence of emotional safety. When children feel consistently accepted, understood, and free from the pressure to conform, they begin to explore, create, connect, and grow—on their own terms. And when we add neuro-informed supports after this foundation is in place, those strategies are far more likely to be effective—because they are received in the context of trust and consent, not compliance. Closing Thoughts: Honor First, Support Second It is tempting, especially in systems that value outcomes and progress, to rush into types of action that align with outside pressures. But when working with neurodivergent children, we must resist this urge. Our priority is to show them they are worthy of care just as they are. Once that message is clear—and once a strong relationship is in place—then and only then can we explore what supports might be helpful. Because when neuroaffirming care comes first, neuro-informed strategies have a much greater chance of being received as tools of empowerment, not tools of assimilation.

Nurturing Wellness: A Highly Sensitive Therapist’s Transformation into the Family Wellness Concierge Model By Kimberly Bartlett, LICSW, LCSW, RPT-S™ March 21, 2024 How does the traditional mental health model fail to consider the needed level of support and role of interconnectedness of mental, emotional, social, and physical well-being in individuals? The traditional mental health model has its limitations that can impact families seeking support. Some common challenges include long wait-lists for appointments, slow responses from providers, and a lack of in-depth feedback and support. Many individuals may feel like just another number in the system, with providers not having a deep understanding or personal connection to their family’s needs. This can lead to a sense of frustration and disconnect in the therapeutic process. It is essential for mental health services to address these limitations and strive for more personalized and empathetic care to truly support families in their mental health journey. I aimed to revamp the conventional therapy approach that often lacks sufficient support for parents. Post-pandemic, I received feedback from parents emphasizing the need for enhanced connection, education, training, and support. By adopting the concierge model, I can offer increased parental assistance. This approach fosters a deeper bond between the family therapist and parent through extended interaction, detailed written feedback on session experiences, analysis and feedback, shared record tracking tailored for parental use, hands-on learning, and practicing essential skills and strategies for their family. Unlike the traditional mental health model, the concierge model provides parents with benefits like timely support when implementing therapeutic strategies at home using a communication method that suits each parent best, visual treatment feedback, tracked changes, progress reports illustrating treatment development, and areas that need attention. Over the years, I have witnessed remarkable outcomes when working with families willing to engage in a meaningful and collaborative therapeutic journey, demonstrating a commitment to follow through and dedicate effort along with my increased availability. These experiences along with the gifts of my nervous system and years of training and experience have motivated me to transition from conventional mental health treatment to a more personalized family wellness concierge model. I recognize that depth work is not only my strong suit but is very much needed in this post-pandemic world where parental and children’s overwhelm and anxiety is at an all-time high. As a highly sensitive therapist, my superpower is caring. My ability to deeply care empowers me to facilitate profound transformational work with families who resonate with my approach. This innovative approach enables me to leverage my sensitivity as a superpower, a gift that I eagerly anticipate sharing with my upcoming client families. A gift that empowers me to excel as an exceptional therapist also comes with certain requirements to maintain its optimal functionality. For highly sensitive individuals, maintaining a healthy balance of stress is crucial. Imagine the nervous system of a highly sensitive person as the engine of a race car – it runs at a higher level compared to others. Just like a race car’s engine, it can overheat more quickly. This means that highly sensitive individuals need to pay closer attention to their needs, similar to how a race car requires frequent pit stops, refueling, and oil changes to sustain high performance. By acknowledging and tending to these needs more frequently, highly sensitive individuals can ensure they continue to function at their best. When applying this understanding of myself into my decision to become a concierge family wellness provider I realize the value in nurturing my nervous system in order to be my best professional self for those I am privileged to serve. A concierge model enables me to deeply invest my heart in selected families who are ready to engage in a thorough exploration of family well-being. By choosing families with whom we naturally connect, both parties have the chance to establish a meaningful therapeutic bond. My innate trait as a highly sensitive person allows me to deeply process and reflect on sessions, enhancing my understanding of my clients. This quality complements my training as an Integrative Play Therapist, where therapists are expected to be introspective, analytical, and reflective. A symbiotic therapeutic relationship which supports families I provide allows me to give my best self, my heart and my highly specialized experience and training. The concierge model of family wellness services offers a personalized and comprehensive approach to supporting parents in their journey towards better mental health for both themselves and their families. By focusing on enhanced connection, education, and support, this model aims to bridge the gap between traditional therapy approaches and the specific needs of parents in today’s world. Through extended interactions, detailed feedback, and tailored resources, parents can feel empowered to implement therapeutic strategies at home effectively. This model not only emphasizes progress tracking but also ensures timely support and visual feedback to help parents navigate their mental health journey with confidence and resilience. By prioritizing the well-being of both parents and children, the concierge model sets a new standard for family therapy, fostering stronger bonds and healthier relationships within the family unit. In the realm of concierge family wellness, I am thrilled to embark on this new chapter of my professional journey. By embracing my unique strengths as a highly sensitive individual, I am poised to offer a level of care and understanding that transcends traditional therapeutic modalities. My vision is to create a nurturing and supportive environment where families can truly thrive, fostering deep connections and sustainable growth. Through this evolution in my practice, I am committed to empowering families to cultivate resilience, foster communication, and embark on a transformative path towards holistic well-being. Together, we will co-create a space where healing and growth are not only possible but inevitable, guided by the unwavering power of care and compassion. The profound connection and engagement with families not only enhance my practice but also have a significant impact on the well-being of each individual I assist. As an Integrative Play Therapist, I can customize my approach to meet each

5 Key Strategies for Cultivating an Effective Partnership with Your Family Therapist by Kimberly Bartlett, LICSW, LCSW, RPT-S™ March 20, 2024 Building an effective partnership with your family therapist is a crucial aspect of successful therapy outcomes. Establishing a strong connection with your therapist can greatly enhance the therapeutic process and contribute to positive changes within your family. Here are some key strategies to help you build a meaningful partnership with your family therapist: Firstly, openly express your needs and expectations. Effective communication is vital in fostering a collaborative relationship with your therapist. By clearly articulating what you hope to achieve from therapy, you pave the way for a more tailored and understanding approach that addresses your specific concerns and goals. Secondly, make sure to follow through with the recommendations provided by your therapist. Consistency and commitment are essential for progress in therapy. By actively engaging in the therapeutic process and implementing the suggested strategies, you demonstrate your dedication to growth and change within your family system. Furthermore, providing feedback on your progress is crucial. Sharing how the therapy interventions are impacting your family allows your therapist to adjust their approach accordingly. This feedback loop ensures that the therapy remains effective and aligned with your evolving needs, leading to a more responsive and adaptive therapeutic environment. Additionally, don’t be afraid to advocate for your needs during therapy sessions. Speaking up for yourself, seeking clarification, or requesting adjustments in the therapy approach empowers you to take an active role in your healing journey. Remember, therapy is a collaborative effort, and your input is valuable in shaping the direction of the sessions for the benefit of your family’s well-being. Lastly, approach therapy as a collaborative endeavor for growth. Engage with your therapist as a team to work towards common goals and foster a supportive environment for positive change. Trust in the process, communicate openly, and embrace the journey of healing and growth with faith in your family’s potential for positive transformation. By building a strong partnership with your family therapist based on communication, commitment, feedback, advocacy, and collaboration, you can enhance the effectiveness of therapy and promote healing within your family unit. By incorporating strategies centered around communication, commitment, feedback, advocacy, and collaboration, you have the opportunity to significantly improve the effectiveness of therapy within your family. Effective communication is key in fostering understanding and resolving conflicts. Commitment to the process is essential for long-term growth and healing. Providing and receiving feedback constructively can help address issues and promote positive change. Advocating for each other’s well-being and collaborating as a cohesive unit can strengthen family bonds and support each member’s individual healing journey. It is important to trust the process, communicate openly, and embrace the healing journey with confidence in your family’s potential for transformation. Remember, healing takes time and patience, but with dedication and a willingness to work together, you can create a nurturing and supportive environment for everyone involved.

There are so many ways that children, teens and families can utilize sandtray and sandplay therapy at Evergreen Play Therapy due to the Integrative Play Therapy approach. When you come into the playroom you’ll see the Sandplay area with shelves full of figurines and objects from fantasy, nature, knights, animals, religious symbols and many more. Our aim is to provide a range of objects that can represent archetypes and other symbols that are critical to people’s experiences. These objects are the basis for self-expression in the sand. The tray is made out of quality wood and painted blue inside. The tray provides a vessel to contain the person’s unconscious and safely hold it in the “world” of the sand. Sandplay is aimed at helping a person bring the unconscious forward. Sometimes words get in the way and the focus of this style of treatment allows symbols to be used to express feelings and experiences that can be on an unconscious level. Creating a 3-d concept of something unconscious allows the person to experience those feelings in a more aware manner that is still controlled and safe. “The purpose of the symbolic process is to help the psyche mature and heal, to move the client through the individuation process in order to confront the necessary conflicts, connect with the deepest layers of the Self, and return to life transformed by this hero’s journey,” said Patricia Dunn-Fierstein of Sandplay Therapists of Amercia. Sandtray Therapy incorporates a range of theoretical models, which means it’s adaptable to people. Sandtray Therapy can include therapist directed activities or prompts. It can be collaborative with a client at the sandtray. Families can be incorporated into sandtray therapy sessions.    

Benefits of Play Therapy Children and their families can benefit from play therapy. Children benefit from having developmentally suited toys and activities to express themselves in an emotionally safe environment. Families can develop stronger family cohesiveness and problem-solving through either family play therapy sessions or by incorporating parents separately while their child engages in play therapy sessions. Play Therapy helps children develop on all levels including socially, emotionally, physically and cognitively. How Will Play Therapy Benefit A Child? Play therapy is implemented as a treatment of choice in mental health, school, agency, developmental, hospital, residential, and recreational settings, with clients of all ages (Carmichael, 2006; Reddy, Files-Hall & Schaefer, 2005).Play therapy treatment plans have been utilized as the primary intervention or as an adjunctive therapy for multiple mental health conditions and concerns(Gil &Drewes, 2004; Landreth, Sweeney, Ray, Homeyer& Glover, 2005), e.g anger management, grief and loss, divorce and family dissolution, and crisis and trauma, and for modification of behavioral disorders (Landreth, 2002), e.g. anxiety, depression, attention deficit hyperactivity (ADHD), autism or pervasive developmental, academic and social developmental, physical and learning disabilities, and conduct disorders (Bratton, Ray & Rhine, 2005).Research supports the effectiveness of play therapy with children experiencing a wide variety of social, emotional, behavioral, and learning problems, including: children whose problems are related to life stressors, such as divorce, death, relocation, hospitalization, chronic illness, assimilate stressful experiences, physical and sexual abuse, domestic violence, and natural disasters (Reddy, Files-Hall & Schaefer, 2005). Play therapy helps children: Become more responsible for behaviors and develop more successful strategies. Develop new and creative solutions to problems. Develop respect and acceptance of self and others. Learn to experience and express emotion. Cultivate empathy and respect for thoughts and feelings of others. Learn new social skills and relational skills with family. Develop self-efficacy and thus a better assuredness about their abilities. Authors The information displayed for the general public and mental health professionals in this section was initially crafted by JP Lilly, LCSW, RPT-S, Kevin O’Connor, PhD, RPT-S, and Teri Krull, LCSW, RPT-S and later revised in part by Charles Schaefer, PhD, RPT-S, Garry Landreth, EdD, LPC, RPT-S, and Dale-Elizabeth Pehrsson, EdD, LPC, RPT-S. Linked mental health conditions and concerns and behavioral disorders were drafted by Pehrsson and Karla Carmichael, PhD, LPC, RPT-S respectively. Research citations were compiled by Pehrsson and Oregon State University graduate assistant Mary Aguilera. APT sincerely thanks these individuals for their contributions!

What is Play Therapy? Play therapy is a structured, theoretically based approach to therapy that is strategically used to help children express what is troubling them. Play allows a safe psychological distance from their problems, which allows them to express their true thoughts and feelings in ways best suited to their developmental level. Research shows Play Therapy is beneficial for people of all ages. A positive relationship with the therapist provides a corrective emotional experience necessary for healing (Moustakas, 1997). Licensed professionals use play therapeutically to help clients better process their experiences and develop more effective strategies for managing their lives. How is Play Therapy Different to The Play My Child Does on Their Own? Play is a natural form of self-expression for children. Children use play to process their lives, cope and develop socially, emotionally, physically and cognitively. Sometimes children get “stuck” in their development and playing on their own isn’t enough to resolve their problems. They need help to use their play to make sense of their world and develop strategies to cope. Play therapists create a safe environment to fully explore their world including areas that they are stuck and past traumas that they are unsuccessful at resolving on their own. Additionally, play therapists are guides at helping to develop new solutions, get past areas that are overwhelming, and develop new perspectives of things that are troubling. Play therapists use many techniques to help children become “unstuck.”  

Types of Play Therapy There are more than 25 “types” of play therapy. Play therapy is a way theoretical models of psychotherapy are used with a client. Just like in “talk therapy” therapists are trained to utilize certain theories of treatment. A talk therapist might use Cognitive Behavioral Therapy as the theoretical model for treatment with a teen or adult whereas a Play Therapist would use Cognitive Behavioral Play Therapy with a child. At Evergreen Play Therapy we utilize an Integrative Play Therapy framework, which allows a range of play therapy models to be drawn from and applied in an integrative way. We also use a model in it’s pure form when appropriate for a session or across sessions. Ask about your therapist’s approach as it could be very different from other play therapists or your assumptions. Some examples of play therapy theories drawn from at Evergreen Play Therapy include (not a full list): Cognitive Behavioral Play Therapy-This is a particularly useful approach for older children and children that are aware, open and ready to discuss the challenges they’ve come to therapy for. Client Centered Play Therapy- In this school of thought the client is assisted in expressing their feelings and finding solutions by being given the opportunity to bring forward what they feel is most critical to them. This allows the child to address what is most difficult through symbolism. The therapist joins their world through accepting symbolism. Narrative Play Therapy- Some clients will come home with written stories or create live action stories with their therapist in session. The focus can be to recreate the story of something difficult and provide a more self-actualizing experience whereby gaining insight and express one’s feelings, cognitions and skills among other benefits. Theraplay- Theraplay is a family therapy for building and enhancing attachment, self-esteem, trust in others, and joyful engagement. It is based on the natural patterns of playful, healthy interaction between parent and child and is personal, physical, and fun. Theraplay interactions focus on four essential qualities found in parent-child relationships: Structure, Engagement, Nurture, and Challenge. Theraplay sessions create an active, emotional connection between the child and parent or caregiver, resulting in a changed view of the self as worthy and lovable and of relationships as positive and rewarding. Example Goals for Theraplay: Increase self-esteem and capacity to feel competent independently. Increase ability to follow directions and accept routines. In treatment, the Theraplay therapist guides the parent and child through playful, fun games, developmentally challenging activities, and tender, nurturing activities. The very act of engaging each other in this way helps the parent regulate the child’s behavior and communicate love, joy, and safety to the child. It helps the child feel secure, cared for, connected and worthy.