Eileen Prendiville in Conversation with Shirley Ward

Shirley: Eileen, it’s great to be with you today – looking around the children’s room here and all the artefacts you have, I am looking forward to hearing about you and your work with children.

Eileen: Thank you Shirley – you are very welcome to Ballymore and the playroom.

Shirley: I understand you have been working with children for over thirty years. What is your background and how did you start working with children?

Eileen: My very first job working with children started back in1975, just after I had finished school. I began working as a nursing assistant in St Josephs, in the St Vincent’s Centre on the Navan Road. One of the first tasks I assigned myself, because I was always a leader, was to ask if I could have the use of a store cupboard to use to set up as a playroom.  I was given it and began to play with children in that context!

We had some amazing results very quickly. One little girl of fourteen began to speak quite fluently although her record had shown she had said ‘Mammy’ when she was eighteen months old and had not spoken since. I went on to do my RNMH nursing training, and Montessori teaching. In every job I did, play became the central focus, and dramatic results were seen with people of all ages, as a result of the play intervention and the relationship.

Shirley: It seems you had a real feel for working with children from a very early age?

Eileen: Yes, from the time I was fourteen I was reading books on psychology, play therapy and Montessori.  As I got older I moved from the nursing and teaching into psychotherapy. I realised that what was so important in all the work I did was the relationship. This was across the board, whether working with children with autism, learning disabilities, or those with no identified problem, enabling children to meet their potential – or working with adults in psychiatric units in groups for the Health Board.

Shirley:  Did it help to have your own children at the time?

Eileen:  Oh it did! When I had my own children I stopped working outside, and worked for myself, setting up a Montessori School and pre-school. I couldn’t decide between either, so I ran both and was able to have my own children with me during the day and they had all the benefits of play and the social interaction of other children too. Eighteen years ago I became involved with the Rape Crisis Centre in Limerick, working as a volunteer. At this stage I was fundraising and from that I set up the Limerick branch of the CARI Foundation. I worked for them for over 14 years and my last position was National Clinical Director.

Shirley:  For anyone who might not know, what does CARI stand for?

Eileen:  It’s Children At Risk in Ireland, a national body providing therapy for children who have experienced sexual abuse.  What makes it unique is that we don’t only pick one identified child. If a child in a family has experienced sexual abuse the other siblings can also attend therapy, family members, non-abusing parents, and extended family; anyone who has been impacted by the abuse, or suspected abuse of that child. Sometimes it has not been validated.

Shirley:  You were based in Limerick but now you have moved.

Eileen:  Yes, that’s right. I am a ‘Dub’ originally. I moved to Limerick eighteen years ago for the volunteer work. It is only in the last three years I have been moving up to this side of the country in Ballymore, right in the heart chakra of Ireland between Mullingar and Athlone. A big change, out in the country – a beautiful change!

Shirley: Eileen, why do children need therapy and how is a child assigned to you, a child psychotherapist? Where do you get clients from?

Eileen: The bulk of referrals would come from the family members themselves. Parents tend to recognise when their own children have a need. It might be rooted in a developmental issue, or rooted in a psychosocial issue. I see children who have been traumatised, bereaved; children with a learning disability that causes them to have trouble with peers; children who have experienced abuse, or children taken into care.

Parents are very tuned into knowing that there are services available that will meet the needs of their child. I run the therapy centre here and also the training, so I offer a referral service, and parents from all over the country contact me to get in touch with a therapist. Teachers, doctors, social workers and lots of other professionals are also involved in the referral of children.

We have reached the stage in Ireland where it is beginning to mushroom and grow. A lot of schools are using their discretionary budgets to employ therapists to provide preventative and intervention play therapy for children in their schools. One of the most amazing things about play therapy as an intervention is that it is an ultimate prevention intervention and play therapy enables children to become more of what they can be. It is not only an intervention that is used for a child who is identified as having a problem or being a problem.  It is also there to enable children to become what they can be.

Shirley:  You speak about play therapy and I read in a previous article that you wrote,   ‘that play is the language of children’. What do you actually mean by that?

Eileen: That is not only my expression, that’s a common expression.  I mean play is a child’s first language. Children can express themselves far more fluently through play. They can tell us about their inner world, their confusions, their development and we just need to learn to understand that language, or re-learn that language as we have all spoken it as children but have forgotten it. When we play with children and we pay very close attention to their play, we are more able to meet their needs, work in a child centred way and enable them to integrate whatever it is that needs to be resolved.

Another important thing is that I see play therapy as a medium that is used by psychotherapists. Play therapy needs to be practised at its best by someone who is qualified in the psychotherapy process so that it is not just an activity based intervention. The whole process in relation to the child is central in there.

Shirley: How would you work with a child with a specific problem?  If there is a child who is angry do you have a specific resource for this specific problem or is it done by experience and intuition?

Eileen: I like the expression, informed intuition. This is how I like to work – using whatever comes from my gut rather than what comes from my head. It usually makes sense in retrospect because the theory has been absorbed and integrated.  I also work with children rather than problems. I see the presenting problem as just being an indication that something has gone wrong. It is like a child with its’ hand up saying “Look at me, something’s wrong. I need something sorting out.”

The overriding common feature of children who are sent for therapy because of emotional issues is that they are confused. The presenting problem is an indication that there is confusion somewhere. There is often a link between the presenting problem and the actual issue behind it. I look at the child’s life story, gather relevant information from people who know the child, and then meet the child. The problems that other people have had with the child are telling that problem from their interactions and relationship with the child. Whereas I have never met the child in relationship with me, so it is from my relationship with the child that I form my own opinions. I always start from a non-directive stance, but know the relationship is going to be more important. The initial few meetings will enable the child to get to know me and me to get to know them.

Children don’t usually self refer, children come to therapy because someone else thinks they have a problem or are being a problem. This is an unpleasant experience for a child. I like them to come in, get a sense of what the process is about, what it might be like and for them to engage in it. I tell them clearly at the end of playing they will be able to decide if they want to come again we’ll make another appointment. I have only had two children who did not decide to come back and it ultimately came to light that both those children were living in a situation where there was an ongoing abuse issue and it would not have been safe for them to engage in the process.  I trust them I never work with children under duress, they are never made to come.

Shirley: I come from a teaching background and would have loved some of my children from school to have come to you.  I think of the children who would get into trouble in school, but when they are naughty there is so much else going on for them and this is what you deal with.

Eileen: It’s a creative adjustment. I applaud children who can act it out as a way of surviving.  We don’t know enough and it would be very unfair and wrong of us to go along and change behaviour when we do not know what’s behind it. The only true change is going to arise from the child. I trust children implicitly to know what is right for them, to make changes at their own pace that fit for them and to act out their process.

Shirley: It must be wonderful for children to come in here. When I look round your therapy room and see puppets, toys, drums, farmyard animals, cars and so many different things for children to platy with.

Eileen:  There has to be lots of dramatic stuff!  In a play therapy environment we are hoping that a child will begin to access ‘as if’. That they will be able to access a sense of what they might be; seeing things that are beyond what are actually current in their lives, in their problem behaviour, their confusions, and begin to look for solutions. It is the risks children take when they are playing, to help try new ways of being, new ways of understanding their world and of looking at problems. I use a developmental play model developed by Sue Jennings that is looking at embodiment, projective and role play. These are three significant types of play that a child moves through and is significant in their quest for identity.

Shirley: Would it help if more people, teachers and parents knew of this? Is there anything that parents could do at home as well, knowing how to use these facilities?

Eileen:  There is a wonderful intervention called Filial Play Therapy where parents are trained to use the skills that are associated with non-directive play therapy in their own homes with their own children. They are not becoming a therapist to the child, but using skills like paying close attention to the child, reflecting on what the child is doing, not judging, not criticising, or even praising because when we praise we apply a standard. They allow the child to lead the play, the parent is fully engaged with them, there are no interruptions, the phone is not going to be answered, the door is locked and the child knows there is a start time and a finishing time. We know non-directive play skills enhance relationships and so for some children Filial Therapy would be the intervention of choice. When the relationship builds up the parents and child will have a resource for ever.

Shirley:  That’s a great step forward if parents really learn this because of course, this is where it all starts.

Eileen: Definitely. I am a firm believer in the power of parents. Any therapy intervention is not going to change their whole world if the rest of the world isn’t ready for them. Parents need help to develop a therapeutic environment sit hay they do not feel the therapist is criticising them either explicitly or implicitly.

Shirley: Do you see children on their own or with a parent or social worker? I ask this because of the Child Protection issues surrounding working with children.

Eileen: I have one creative solution. I know that I don’t pose a risk to children so I do not see there being a child protection issue in my relationship with a child. I am not afraid of a false allegation. I know that one of the consequences of the fact that paedophiles exist, is that lots of adults allow their relationships with children to be impacted on in a negative way so that the child does not have such a rich an experience that they might have. I remember working with a four year old in foster care. The foster parents had been told they could not go to the bathroom with the child, even to assist with her toileting. The foster father could not bath her or go swimming with her. All these things were crazy as this child obviously needed parenting and healthy touch.

Therapy takes place in a one to one situation in a room that is closed, having the same container that adults have when they go to therapy.  I always give the child the option to have the door open or closed, if they are anxious or nervous in any way.  It is a good idea to have a camcorder set up permanently in the room, enabling a supervisor to watch parts of a session as an extra protection. My highest priority is the therapy process for the child and I do not have bars against healthy touch if a child wants to hold my hand, or I rub a bumped knee or head.

Some people say that there can be no physical contact. Attachment for me is touch based. I do not think there can be a successful attachment relationship without touch. I don’t think that necessarily means that the therapist is the person who is involved in a physical relationship with a child. The holding of hands or patting of the head might be but children should not be told there can be no touch here. That is very false and very unfair and would allow paedophiles to impact on the child getting their needs met.

Shirley:  It does cause a lot of people conflict when working with children today.

Eileen:   Definitely. There are some concessions that need to be made. There may be glass panels in the door that someone can look in but not compromise the confidentiality. Children need to be clear on what the limits of confidentiality are. It does not mean that they cannot tell anyone about anything that has happened in the room. Children need to be sure that they can tell anyone in the family anything and everything in relation to that.  Confidentiality is not a secret because there are some parallels. Child abuse happens in one to one relationships in closed rooms as does therapy. We need to be very clear that a child does not get confused in any way by the confidentiality arrangements.

Shirley:  I read in an earlier Inside Out article that you wrote in 2003, and I quote ‘The family will not be able to support the child’s development to healing if they have serious unmet needs of their own’. Do you believe that the needs of families are met today in Ireland by agencies or do you believe the Government and HSE could provide more? What gaps are there in the family support system?

Eileen:  There are a lot of good intentions but a lot of gaps. Some of the gaps arise from an over legalistic system. Agencies protect themselves rather than children. We find children who are not protected in the face of abuse, disclosures or very significant concerns.  Non-abusing parents can find themselves being blamed rather than being supported and empowered. If there is an allegation of abuse there can be an expectation that it is false or a parental dispute.

I have worked with parents who have not been abusive but have spent years in and out of court trying to protect their children – and our system does not give parents the right to protect their own children. A parent cannot say to their child, this will never happen again, I am going to keep you safe. I am not letting him or her, or whoever it is, hurt you again. Parents cannot guarantee this.

We house a system where a person who is related to a child by blood is more able to continue to abuse a child.  For example, if I had a child and it was abused by a neighbour the system would oblige me to protect my child. If I allowed my child to go back into the house again and they were abused again I would be deemed neglectful. However if my child were abused by a family member, someone who had a legal right to have contact I could have my child removed from my care unless I allowed my child to have contact with the offender. I have worked with children who have been dragged screaming for contact visits, and contact visits have been unsupervised from Friday nights until Sunday nights even with known offenders. I don’t think that there is any way we can say this protects children or that the system is meeting the needs of children.

Shirley: So are you saying the legal system needs updating?

Eileen: We do not have education for judges. We have professionals who do not understand the dynamics of abuse.  We have gaps in supports that are available to professionals. Social workers have horrific workloads. Some may be twenty one, very young and inexperienced to deal with families where there is horrific violence and are trying to establish a safe place for a child.

Shirley: The national bodies for psychotherapy do not have sections for child psychotherapists but I believe you are starting a national body in Ireland?

Eileen:  Yes. I have been closely involved with other interested people in starting a national body called Play Body Ireland. It is time for Ireland to have national standards for Play Therapy as a branch of psychotherapy. We have done this in accordance with the national standards for psychotherapy and play therapists will be qualified on a par with psychotherapists. We looked at IAHIP standards and European standards trying to ensure that play therapists will have intensive training. I don’t see why people who work with children primarily cannot be accredited by the broader bodies like IAHIP or whatever umbrella branch of ICP. Any therapist who works with children is obliged to work with adults because we work with children in a systemic way. It is not possible, neither is it ethical, to work with a child in isolation.

Shirley: Do you believe that psychotherapists who are working with adults need specific training before working with children?

Eileen: They honestly do. I get a little annoyed when I hear of people with no training with children being promoted for positions that are exclusively working with children. What this is doing is seeing children as small adults, not recognising that the process is very different and more complex than working with adults. Adults bring themselves to therapy, make changes in their world, make choices, and engage in an equal relationship.  Children don’t have that. They are developmentally immature. I always say it is developmentally appropriate for a child to be immature. They cannot be independent and it would be wrong for us to make children independent. We have to think about how we equalise our relationship with children; how do we give the child power without giving them the responsibility. A more complex training is required as it covers the whole range of adult therapy plus more, so yes specialised training is necessary.

Shirley:  So if I decide to come on one of your courses and I recommend other people to come, particularly psychotherapists who want to work with children, what would we learn?

Eileen:  What it means to work in a child centred way. How we structure our work when we have a child as a primary client because that involves having adults as secondary clients. Learning to read play; re-learning the language of play; learning the therapy process for children; learning to tell the difference between a child who is adjusted and a child who has an adjustment difficulty and how can we tell that in the process. Learning to look at concepts like beginnings, middles and endings because we find children come to therapy and some can do beginnings and some endings.

The core point of therapy is obviously in the middle so we have to learn if a child is one who has difficulty dealing with core issues or is this a child who is not safe enough to be ready with core issues. If that is the case, then we have to stop therapy being a full therapy process and it becomes a way of enabling a child to cope consciously. Students also learn a lot about expressive arts, how to use art, drama, music, movement, as well as play therapy.

Shirley:  That sounds like an enormous amount of exciting things for people to learn!

Eileen:   It is all experiential learning!  There is nothing that a therapist will learn on a course geared towards working with children that would not be of benefit working with adults.  We heal at the developmental stage we are at, when a trauma occurred.

A client with a trauma at 3,4,5,6 or 7 years of age will not heal from verbal therapy alone, the creative therapy and expressive arts are vital for healing. Students, the first time they get on the mat for a play session realise it is their own story, their own issues. You are never playing at being a child. All you are doing is getting to know your own inner child.

Shirley:   Because I am interested in the Pre and Perinatal area of life,  that is life in the womb and the difficulties that trauma in pregnancy and birth present in life , do you ever notice any birth trauma that might come up when working with children?

Eileen:   Yes. Definitely.  I start from an interactive play position and have frequently seen children engage in rebirthing activity as part of a non-directive approach.  It is not something I instigate or set up but it is definitely something that takes place. One little boy I worked with was six, and he had had a very early trauma, not necessarily at the birth.  He was cared for very soon after birth in a household where he was actually abused by a neighbour. It was the perfect childminding scenario, but a number of years passed and it became clear that some children in that same house had been abused, an investigation took place and it turned out that this little boy had also been abused.

I worked with him using non-directive play therapy and he regularly used the Wendy House. He’d go in and have me fill it with cushions and beanbags, then I would go in and he’d fill it up too.  I was careful we had enough air to breathe! We would have to find our way out!  At one stage he set up a play space in the room where he used a whole corner of the room, mattresses on the floor,mats around the edges to make an enclosed space and in one part he had a table. He went in behind his table and I had to put all the soft toys, cushions and beanbags on top of him.  I had to sit on the table! Next thing I heard him behind me saying ’I’m coming!  I’m coming! I see a light! I see a light!’  I thought to myself what on earth is going on!   He is saying ‘I see a light! I see a light!’ and the next thing I know he is under the table I am sitting on! He tells me that I have to put my legs apart. The next thing he is saying again ‘I see the light! I see the light!’ and all I could do was say ‘Push! You need to push! Can you see the light? Push!’ He did and he emerged from between my legs into the room!

I thought this was really significant because this was a child who had been abused from literally days old. What he did the following week was he set up the same section again but this time he had arranged for his parents to stand outside the door of the therapy room. They were told that at some point they would have to try and open the door. The next week he set up all the cushions and beanbags behind the door. When his parents came outside, he crawled under it and they had to push the door open and he emerged, crawled, slithered out through the door to them. I think he was being reborn to them. They were very supportive, protective parents and he was giving them the opportunity to start again from scratch. It was a huge turning point in his life.

Shirley:  Eileen that is amazing because every child who comes to you is reborn in so many different ways. With all the different skills you have and the techniques you use, and the love that you have for these children, they are all being reborn.

Eileen:  That is a lovely way to put it. I don’t think there is anyone who can’t recover. No matter what experiences or traumas exist. No-one is beyond recovery or beyond reclaiming that childhood and getting back to being the child they would have been if the difficult experiences had not occurred. I remember one non-abusive mum said to me after a long period of work with her child who had experienced extreme abuse by a ring, said: “You told me it would happen but I didn’t believe you. You told me she would come back and now I see her. She is exactly as she would have been had this not happened”.

Shirley:  That is a wonderful, positive note to finish this conversation. On behalf of all the children you work with, and the people you train, thank you Eileen, and I wish you well for the future.

Eileen:  Thank you Shirley.  It’s been lovely talking to you.

Eileen Prendiville can be contacted at prendivilleeileen@eircom.net and the website is www.childrenstherapycentre.ie