Experiential Therapy: Therapy outside of the box

When seeking therapeutic support, there are options available that take therapy outside traditional office walls and methods, such as experiential therapy.

Psychology Today defines experiential therapy as a technique that “utilises expressive tools and activities, such as role-playing or acting, props, arts and crafts, music, animal care, guided imagery, or various forms of recreation to re-enact and re-experience emotional situations from past and recent relationships.”

These methods can be used as a person’s sole therapeutic outlet, or in conjunction with traditional therapy or psychiatric visits. Here are some examples of Cayman’s experiential therapy options.

Therapy Dogs

Therapy dogs are trained to provide support and comfort to those in places or situations which may be causing discomfort. Therapy dogs work regularly in hospitals, nursing homes, schools and hospices, among other areas.

Healing Paws are a local volunteer organisation offering certified therapy dogs and handlers who help those in the community who have physical, emotional or psychological issues.

Healing Paws regularly visits The Pines.

The dogs provide the support necessary to improve the affected person’s social, emotional, physical or cognitive functioning.

The organisation began in 2011 with a few women running it part-time. When they left the island, they asked Dr. Denise Osterloh if she would like to continue the cause and she accepted. Dr. Osterloh is now medical director and built up the group with the help of Tracy Stone, Fiona Graham, and dog trainer Heidi Suarez.

“We believe that through the love of the animal and their interactions with people, we can help people in various ways,” explained Dr. Osterloh. “For example, just hugging a dog can reduce one’s stress and anxiety levels, especially if they are ill. We also use the dogs as companions to children when they read to help the children to relax, and we also use the dogs to help children in need.”

Despite increasing popularity of this form of therapy – there are more than 50,000 therapy dogs in the U.S. alone, as well as numerous studies outlining its benefits – there is still an uphill battle regarding their use in Cayman.

“Unfortunately, there is still a stigma about therapy animals and their uses are limited here due to this,” explained Dr. Osterloh. “It is a daily challenge to change this.”

The puppies persevere however, and regularly assist with the Special Needs Foundation book readings, and at The Lighthouse School and The Pines Retirement Home.

EAP promotes human physical and mental health.

Equine-Assisted Psychotherapy (EAP)

Equine-Assisted Psychotherapy involves activities and interactions between clients and horses, supervised by mental health professionals and equine specialists.

“This form of experiential therapy is helpful for most emotional or relationship difficulties that may arise, but with a growing evidence base for persons who have experienced trauma and persons with addiction,” explained Dr. Alexandra Bodden, whose clinic OnCourse Cayman offers EAP co-facilitated by Ms. Shanna Pandohie, equine specialist and owner of Cowboy Town Stables. EAP can be done individually or with groups in both therapy and workshops.

During EAP, the therapist observes and interacts with the client to identify behaviour patterns and process thoughts and emotions, identify emotional and behavioural challenges, and develop necessary skills and attributes. Activities used can represent goals or difficulties in client’s lives, and client issues are often reflected in the arena with the horses and can be processed through metaphors, providing a safer and less intimidating forum.

“Activities are developed depending on the client or team’s goals and needs, such as problem-solving, frustration tolerance and emotional regulation, building and improving relationships and effective communication. As it is a client-centred model, the processing of the activities will be directed by the client’s interpretation and understanding of the experience with the horses and then further developed through reflection and elaboration on ideas with the EAP team afterwards,” explained Dr. Bodden.

OnCourse Cayman offers EAP through the Equine-Assisted Growth and Learning Association (EAGALA) model, where a mental health professional and an equine specialist work with the person with a horse or horses in the arena. The model involves only groundwork, no riding, so that the horses can freely respond to people involved.

“In this way, they are able to provide genuine feedback to the person in the moment and through their observations and interpretations, the facilitators can assist with further development of insights and skills relevant to them and their experiences (in the arena and out).

“EAP is a unique and powerful way of approaching life’s problems to gain new perspectives and insights into ourselves and our lives,” said Dr. Bodden, who added that this therapy is very adaptive to the clients being served but additional support may be needed in cases of severe mental illness or significant delays or intellectual difficulties.

Art Psychotherapy

Art psychotherapy uses creative techniques to help people express themselves and to improve and enhance physical, mental and emotional well-being. It can help people to resolve conflicts, develop interpersonal skills, manage behaviour, reduce stress, increase self-esteem and achieve insight. It is often used to assist those suffering from mood disorders, anxiety and depression, addictions, eating disorders, trauma and other emotional dysregulation.

Art psychotherapy is multi-faceted and can be delivered in a variety of ways.

“In short, it is therapy for issues that are beyond words,” explained Anne-Marie Diaz, programme facilitator, and certified art therapist, at the Family Resource Centre, who holds a masters in art psychotherapy from the University of Roehampton.

“Typically, the art acts as an additional or alternative method of communication between client and therapist and the artwork is often used as a way for unresolved issues and subconscious material to come to the surface,” Diaz explained. “The client can start to better understand their inner world, and process and work towards agreed goals. The process of making the art, in and of itself, has healing properties as does the relationship formed with the therapist and the support provided.”

Clients can choose to work on specific goals and pinpoint these in collaboration with the therapist.

While anyone can benefit from art psychotherapy, Diaz says typically clients are children, adolescents and adults with cognitive or physical disabilities, challenging behavioural issues, various forms of psychosis, eating disorders, PTSD, abusive and traumatic experiences, as well as dementia.

Clients need no art skills or even an interest in art as the method is used for exploration and understanding, not to create art that looks ‘good’. The emphasis is on the process, not the end result.

“Some clients, usually adults, enter being apprehensive about using art medium for a variety of reasons, but once they begin engaging with making art, the healing in the making and in the processing with the therapist soon become forefront,” said Diaz.

Play Therapy

“Play Therapy is a modality of psychotherapy that involves working with children using their most effective way of communication – play,” explained The Wellness Centre’s Feleicia McField, who is a clinical mental health counsellor and registered play therapist with a bachelor of arts degree in psychology and master of science in counselling. “This involves the therapist working to see and experience the world of the child, through the child’s eyes and own experience.”

Through this medium, children can better express thoughts and feelings in a physically and psychologically safe place. This can increase self-esteem, self-confidence, emotional-regulation and coping skills, self-awareness, empathy, respect for others, and improve emotional growth, creativity, family relationships, social skills, problem-solving and decision-making skills.

This form of therapy is typically provided for children between three to 12 years old who present with challenges such as anxiety, depression, domestic abuse, neglect, natural disasters, and family issues. It can also be used within therapy for attention deficit hyperactivity disorder (ADHD), autism spectrum disorder (ASD), traumatic brain injuries (TBI), fetal alcohol spectrum disorders (FASD) and more.

“Through play therapy, safe opportunities are provided for the child to fully express and understand their feelings, thoughts, experiences, and behaviours while simultaneously expressing to a child that their thoughts matter and can be processed through their most comfortable medium of communication, play,” said McField.

There are different types of play therapy: Child-centred play therapy (CCPT), Cognitive-behavioural play therapy, Adlerian play therapy, Gestalt play therapy, and Jungian play therapy.

Additional play therapy-based intervention services can also strengthen parent-child relationships. Group play therapy is also available involving siblings or small groups of children as a social, emotional, and behavioural intervention to help increase peer or siblings’ relations.

McField said “I am excited to be a part of the efforts in the Cayman Islands to normalise the utilisation of therapeutic services that help provide additional psychological and/or psychosocial education, resources, and utilisation for all populations.”

Music therapy can be used in individual or group settings.

Music Therapy

Music therapy uses music to address a number of physical, emotional, cognitive, and social needs of individuals of all ages and abilities. This therapeutic method is used by a board-certified therapist and can be used in individual or group settings, and in combination with other therapies.

After assessing the needs of each client, the therapist will utilise techniques such as listening, creating, singing, or moving to music. Immersing people in music can allow them to more easily express themselves, identify and process difficult experiences, develop social and communication skills, or simply find emotional release and improve health and well-being.

This process can provide a medium for communication and expression that may go beyond what is easily expressed in words.

“Through musical involvement in the therapeutic context, clients’ abilities are strengthened and transferred to other areas of their lives,” explained Julianne Parolisi, founder and director of Cayman Music Therapy, who is a board-certified music therapist. “Music therapy also provides avenues for communication that can be helpful to those who find it difficult to express themselves in words.”

The therapy is evidence-based, and it has been found to be effective in providing outlets for expression of feelings, overall physical rehabilitation and facilitating movement, providing emotional support for clients and their families, and increasing people’s motivation to become engaged in their treatment. It can be used to help people of all ages and abilities including children, adolescents, adults, and the elderly with mental health needs or developmental and learning disabilities; older adults with Alzheimer’s disease and other aging-related conditions; and individuals with substance abuse problems, brain injuries, physical disabilities, and acute and chronic pain, including mothers in labour.

A wide range of musical styles and instruments can be used, allowing people to create their own musical language in which to explore and express themselves.

“Music therapy is a fun, engaging way to work towards therapeutic goals,” said Parolisi. “We often find that those who are most resistant to standard treatment options are willing to open up through music in new ways.”