Theory and Practice of Contemporary Psychotherapies

Play Therapy Technique: Butterflies in my Stomach Video Transcript

Butterflies in My Stomach is an assessment activity used to evaluate the child's presenting problems and concerns. It's taken from one of my books, Creative Interventions for Troubled Children and Youth published in 1999.

The activities are appropriate for children aged six and up. I introduce the activity by reading the following instructions to the child. "This activity will help you talk about your problems and worries. It is called Butterflies in My Stomach because when you're worried or nervous about something, your stomach might feel funny or jittery as if you have butterflies in your stomach. You don't really have butterflies in your stomach. It just feels like you do."

Then I normalize that everyone has problems and worries. I have problems and worries. Kids at school have problems and worries. Everybody has problems and worries. So, today we're going to talk about your problem and worries. I'd like you to think about the problems and worries you have, and I'd like you to write each of your problems or worries on a paper butterfly. You can get paper butterflies by photocopying the template from the book, or you can simply draw your own. There are three different sized butterflies. And, so I ask the child to write bigger worries on the larger sized butterflies, medium worries on the medium sized butterflies and smaller worries on the smaller butterflies.

After the child has written his worries on the paper butterflies, the butterflies are then glued onto a body outline, and you have a couple of options here. You can either bring in a precut body outline, or if you have large banner paper you can have the child lay down on the paper and trace the child's body onto it. Or you can simply have the child draw his or her own body, and then glue the butterflies inside his stomach. If the child is having difficulty identifying his own worries. Then I might first generalize it and ask, "What kinds of worries do you think other kids have?"

And, then once we've had a discussion about the typical kinds of problems and worries that kids have in general, then I ask again, "So, what are some of the worries that you have?" Again, if the child is still struggling to identify his worries, then I can ask prompt questions such as, "What's a problem or worry you're having about school?" Or "What's a problem or worry you're having at home? What's a problem or worry you're having with friends? Or I might simply ask "What's something that's troubling you this week. A worry that you're having this week?"

Here's an example of activity. This one was completed by a nine year old boy who was referred to me because his mother had died of cancer. His biggest worry is that dad will die too. This is a common concern of children who are dealing with the death of one parent. Often they're worried that the other parent will die too.

A second worry that he identified is I will catch cancer and die. Many children dealing with the death of a family member through cancer believe that cancer is contagious and they're worried that they can catch it and then they'll die.

A medium sized worry that he identified is kids will be mean to me. He then talked about being teased by other children.

A fourth worry that he wrote on the smallest size butterfly is, "I will fail my test." And, he identified that since his mom has died, he's having trouble concentrating on his school work.

Now, this child was able to respond to some of my process questions during the activity, I generally wait until the child has completed writing all of his worries on the butterflies until I go back then, and process. I might invite dialogue by asking questions like, "I see you're worried that your dad is going to die too. Can you tell me more about that worry?"

I also use the activity to evaluate the child's problem solving abilities. For instance, I might ask the child, "When other kids are teasing you, what is something that you can do to try to solve that problem?" I also used activity to evaluate the child's support system. So, I ask "Who are some people who can help you with your problems and worries?" This activity is a valuable assessment tool. It's concrete and children seem to respond well to it. It also helps to externalize the problem.

When children have a lot of worries or feeling very distressed. Often it comes out through psychosomatic symptoms like stomach aches or headaches. They may be having a lot of nightmares or intrusive thoughts and so this activity helps to externalize the problem, taking it out of here, where it's causing all kinds of internal distress, like stomach aches, nightmares, those kinds of things. And, putting it down on here by writing about it, by drawing about it, by writing worries on paper butterflies, that helps to get it out. To externalize the problem.

The activity for facilitates catharsis of overwhelming problems and feelings. And, it's an especially helpful assessment tool for children who present with a multitude of problems. It helps the child to identify their various problems and worries. And, it also helps the therapist to set priority goals for treatment because obviously the bigger problems, the bigger worries are the ones that require priority in treatment.

Butterflies in My Stomach is one technique that I utilize as part of an overall more comprehensive assessment. In future videos, I'll be demonstrating additional assessment techniques.