… Reentering Steven’s room, I stopped at the sink to fill the bedpan with warm water, placing the filled bedpan on Steven’s rolling bedside table. The sheets and towels went on the floor against the wall opposite the foot of his bed. Steven’s eyes followed my every movement, showing curiosity and anticipation

So, here’s the deal.” I said. “Lots of kids have stuff happen in the hospital that they find upsetting or scary. Sometimes it helps to get these feelings out in a physical way. I am setting up a target game, where you will get to throw wet toilet paper at what is upsetting you until it is completely destroyed. The question for you now is, do you want to destroy the drawing of your hand, or is there some other thing you could draw that you’d like to obliterate?”

Steven picked up a marker, so I brought over the big piece of chart paper. He got right down to work, drawing a huge needle that took up the entire sheet of paper.

“Oh,” I said. “That looks like the needle that might have to go in your hand.”

He nodded. When he finished, I took it from him and taped it on the wall opposite his bed.

“Now for the demonstration,” I said, reaching for the roll of toilet paper. “See, you take as much as you can to make a nice, big wad.”

I unrolled it from the tube, wrapping it around my hand.

“Now, here’s the most important part. You dip it in the water, but you don’t squeeze any of the water out, so it’s sopping wet.”

Steven was riveted.

“Throw it as hard as you can at the target, yelling what makes you mad or scared.”

Winding up my arm like a star pitcher, I let go of the wad.

“I hate needles!” I yelled.

As my voice filled the small room, the toilet paper thwacked solidly against the drawing of the needle, sticking there a moment before falling to the floor. I turned to Steven.

Steven sat straight up and reached for the toilet paper roll. He followed my actions, and as he whipped his TP bullet at the target, his voice rose to a throaty yell.

“I hate IV’s!”

I applauded him and he took it from there, yelling out the things that had been bottled up inside, until the chart paper sank to the floor in defeat. For the last few tosses, he rose to his knees in the bed and used  his whole body to fling the wet mound at the target. It took a while to clean up the stray clumps of sticky toilet paper and mop the floor with towels, but I didn’t care one bit. Steven was now talking  animatedly with his dad and he ended up in the playroom not long after.

I learned about this technique at a play therapy training seminar from Heidi Kaduson. She writes about the activity in her book, 101 Favorite Play Therapy Techniques Volume III. Many techniques from other disciplines are readily adaptable to the hospital environment, and this one in particular has brought relief and laughter to many children and teens facing extended hospitalization, isolation and painful procedures. I’ve also used it  in a parent respite group with great success. If the child is unable to draw or write, they can always dictate to you and have you act as the scribe. I’ve learned that kleenex and paper towels don’t work as well as toilet paper. They don’t make that wonderful “thwack!” or provide enough proprioceptive feedback to the child. I’ve seen specialists experiment with food coloring with great success, but of course it is a bit messier. Taking before and after photos for the child, preferably on the family cell phone if there is one, can be especially validating. Either way, the process of getting a child’s fears or anger onto a piece of paper and role modeling how to obliterate it, is a win-win for all.

Bullseye!