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child
clinical psychology and play therapy
Clinical
psychology includes
the scientific study and application of psychology for the purpose of
understanding, preventing, and relieving psychologically-based distress or
dysfunction and to promote subjective well-being and personal development.
Central to its practice are psychological assessment and psychotherapy,
although clinical psychologists also engage in research, teaching,
consultation, forensic testimony, and program development and administration.
In many countries clinical psychology is a regulated mental health profession.
Clinical
psychology may be confused with psychiatry, which generally has similar goals
(e.g. the alleviation of mental distress), but is unique in that psychiatrists
are physicians with medical degrees. As such, they tend to focus on medication-based
solutions, although some also provide psychotherapeutic services as well. In
practice, clinical psychologists often work in multidisciplinary teams with
other professionals such as psychiatrists, occupational therapists, and social
workers to bring a multimodal approach to complex patient problems.
Child
experts agree that significant childhood problems—including poor bonding with
parents—shape future adult work and social relationships if not treated.
“Children who don't get the attention they need in the early developmental
years may have a limited capacity for intimate attachments, or an inability to
commit or empathize as adults,” notes Dr. Ana Badini, a psychotherapist who has
treated adults and children for over 18 years.
Therapy
can help children resolve current problems, as well as provide tools to cope
with life challenges later on.
Child Counseling
Counseling
for children is a tough process for many parents. Some feel their child doesn’t
need it and choose to overlook potential problems, while others feel their
child will be stigmatized for undergoing therapy.
There
is also a common belief that children are resilient enough to simply “bounce
back” from traumatic events or emotional issues, but this belief is dangerous.
Children are often the most vulnerable to damage from trauma because they don’t
fully understand what they’re going through. Child counseling gives them an
opportunity to explore the issue in a safe environment with a professional who
is trained to guide them through the healing process.
Types of Child Counseling
There
are many types of therapy geared specifically to children. Just a few of these
include:
Benefits of Child Counseling
Children
often don’t know how to express their emotions properly, and it usually takes
them longer to adjust to major life changes. Though they are good at hiding
their struggle, warning signs of a child in crisis can include mood swings,
misbehaving in school or at home, and depression or withdrawal from daily life.
Talking
to a counselor can help children vocalize their problems and get to the root of
the feelings that they don’t understand, yet are causing their sadness and
anxiety. It can also help control or prevent many of the symptoms listed above.
§
Finally, the process can also help parents better understand
what their child is going through without feeling pressured to solve the
problem or guilty because they believe themselves to be the cause. Though such
counseling is primarily for the benefit of the child, it often acts as a form
of family
counseling, bringing all members
§
Paul is six years old, and he became very withdrawn after his parents
separated. Struggling with a learning disability, he seldom speaks, but
expresses his feelings through vivid crayon pictures.
§
At age nine, Danny complains that he can’t get rid of “bad
thoughts” in his head. Every night, he compulsively counts all his toys before
going to sleep.
These children are grappling with emotional pain and hardships at
very early ages. Unfortunately, they are not alone—thousands of children face
complex life issues that often stem from fractured, dysfunctional family
structures and a fast-moving, technological society.
According
to the
Sometimes,
the symptoms are vague. “Often a parent brings a child to therapy because
he/she knows there is a problem, but is not sure what it is,” says Lorenzo
Colon-Monroe, Director of the Den for Grieving Kids in
The
most common therapeutic approach for children ages 4-11 is play therapy. In
play therapy, children use dolls, art, and games to express their thoughts,
experiences, feelings, and conflicts to the therapist. The therapist may
observe and/or interact with the child during play, using talk or play objects
to communicate.
Depending
on the child's verbal abilities and maturity, talk therapy or
cognitive-behavioral methods may be used with children aged 12 and older.
Before the First Session
If
you've decided on child therapy, Colon-Monroe suggests that you prepare your
child before the initial session. “If they don't understand why they're here,
children may be fearful, anxious, or may interpret therapy as punishment,” he
says. “This interferes with the initial bonding process, and can adversely
affect the process.” When talking to young children, he suggests you explain
that a therapist is a “talk doctor” with “no needles,” and emphasize to the
child that they are free to tell the therapist any problems. Badini also
suggests that parents present the therapy as “teamwork”— something that “we”
are going to do together to help “us.”
Certain
psychological or behavioral disorders may be treated with medication as an
adjunct to other types of therapy. Some conditions treated with medication
include:
Although
medication can help reduce or eliminate symptoms, it should not be prescribed
lightly. All psychiatric medication should be prescribed by a physician
experienced in treating psychiatric problems in children and adolescents, and
the course of treatment should be monitored very closely by both parent and
physician. If medication is recommended for your child, discuss all
ramifications of the treatment with your doctor.
Counseling
benefits divorced children can recieve from group counseling include things
like a sence of belonging, a sence that their problems are shared with their
peers and the development of positive coping skills. To get the most benefits
from group therapy the right form of this therapy needs to be found. For
example, while teens may benefit from peer group therapy, younger kids may
benefit more from family group therapy.
In
addition to group therapy options, counseling benefits divorced children can
acquire can also be gained through individual counseling. Individual counseling
sessions work well for young kids, teens and even for adult children of
divorce. The benefits here will focus on emotional release, the development of
coping skills and the ability to deal with stress.
In
order to get the most out of a counseling program several factors have to be met.
First of all the right counseling setting has to be selected, either group or
individual. Next the right approach to the counseling experience needs to be
offered by the counselor. Finally, the right match between your child and a
counselor needs to be sought. When all of these things work, magic can happen.
Why Therapy?
Unresolved problems or disorders can impede a child’s development
or trigger emotional states that cause trauma for the child, the parents, and
the family. The effects may be long lasting.
Child experts agree that significant childhood problems—including
poor bonding with parents—shape future adult work and social relationships if
not treated. “Children who don’t get the attention they need in the early
developmental years may have a limited capacity for intimate attachments, or an
inability to commit or empathize as adults,” notes Dr. Ana Badini, a
psychotherapist who has treated adults and children for over 18 years.
Therapy can help children resolve current problems, as well as provide
tools to cope with life challenges later on.
Child
counselling aims to help children cope better with their emotions, understand
problems, develop necessary coping skills and make positive choices. During
counselling children are encouraged to explore and express their feelings
through one of many media depending on the child’s individual preference e.g.
talking, artwork, telling stories, drama or play.
Child counselling is helpful to:
·
Children who find it difficult to acquire social skills.
·
Children who have experienced loss through family breakdown or
bereavement.
·
Children who have experienced abuse.
·
Children with low self esteem, anxiety or depression.
·
Children whose behaviours are potentially life threatening.
I
think its very important to have clinical child psychology to resolve conflicts
of child such as the effect of divorce on children.
Unresolved problems or disorders can impede a child’s development
or trigger emotional states that cause trauma for the child, the parents, and
the family. The effects may be long lasting.
Child
counselling aims to help children cope better with their emotions, understand
problems, develop necessary coping skills and make positive choices. During
counselling children are encouraged to explore and express their feelings
through one of many media depending on the child’s individual preference e.g.
talking, artwork, telling stories, drama.
Child
clinical psychology may have better outcomes for a healthy future for a child.
What are the techniques employed in
play therapy?
Play Therapy
Play therapy
is based upon the fact that play is the child’s natural medium of
self-expression. It is an opportunity which is given to the child to “play out”
his feelings and problems just as, in certain types of adult therapy, an
individual “talks out” his difficulties. These children range in ages 4 to 12.
Play therapy
may be directive in form that is the therapist may assume responsibility for
guidance and interpretation, or it may be non directive: the therapist may
leave responsibility and direction to the child.
Play therapy refers to a method of psychotherapy with children in
which a therapist uses a child's fantasies and the symbolic meanings of his or
her play as a medium for understanding and communication with the child.
Because children's language development lags behind their cognitive
development, they communicate their awareness of what is happening in their
world through their play
Because the child's
world is a world of action and activity, play therapy provides the psychologist
in elementary-school settings with an opportunity to enter the child's world.
In the play therapy relationship, toys are like the child's words and play is
the child's language. Therefore, children play out their problems, experiences,
concerns, and feelings in a manner that is similar to the process of talk therapy.
Directive vs. Non Directive Approaches
There is an ongoing debate in the play therapy field over which
approach is “better” – non-directive or directive. There are two issues
of concern. First, there is not one right way to proceed in our work with
children. Contrary to the dogmatic views of some theorists in the field,
many approaches work with children. Second, it is highly questionable
that there is really any such thing as non-directive therapy. The term
“non-directive” is a misnomer.
A therapist should be fairly non-directive in the therapeutic process, often
quite directive with regard to the methods used in a session, and as non
directive as possible with regard to the interpretation of the material which
arises during a session, and quite directive in the issues of safety and best
interests of the child.
Therapists who call themselves non-directive or client-centered are often only
non-directive in terms of what they do in a session. They suddenly become
very directive in interpreting and analyzing the client’s inner world and
reflecting back to the child.
The goals of
play therapy are to help the child with the anxiety/conflicts/symptoms that
precipitated the referral to the therapist and to work with the child and
family to remove any obstacles that threaten to interfere with the child's
future optimal development. In the play therapy sessions techniques for
engaging and communicating therapeutically with children are demonstrated as
well as strategies for working with children of various ages. The purpose of
employing techniques (and play materials) in play therapy is to enhance
communication with the young child. The techniques must be considered as tools
in the complicated process of engaging, assessing, and treating the child
through play therapy.
Hanney and
Kozlowska,(2002) emphasized that preschool children who are confronted with
stressful situations or memories experience a physiological response of hyperarousal,
which undermines their ability to utilize their developing cognitive capacity.
Physiological responses of overwhelming anxiety, fear, and distraction may make
many children unable to participate in family-therapy sessions because they are
unable to access these traumatic memories and to verbalize their feelings.
For example
a seven year old boy, in the middle of the play therapy session cried out
spontaneously, “ Oh, every child just once in his life should gave a chance to
spill out all over without a “Don’t you dare! Don’t you dare! Don’t you dare!”
That was his way of defining his play therapy experience at the moment.
For example,
a first-grade student in the sensory-motor stage may not be able to properly
express that he is sad about his parents' divorce. Instead, he may demonstrate
his egocentric thinking by stating his wish for his parents to attend his
baseball game so that they can see how much fun they can have as a family.
Another child may not even able to verbalize her emotion; instead, she may pull
out pieces of her hair to display the intensity of her anguish over her
parents' divorce (Myers, Shoffner, & Briggs, 2002).
The
therapist realizes that non directive therapy is not a panacea. She admits
that, like all things it too has its limitations, but accumulating experiences
indicates that the implications of this type of therapy are a challenge and an
inspiration to those who are concerned with the problems of adjustment
When
a child comes for play therapy it is usually because some adult has either
brought him or sent him to the clinic for treatment. He enters into his unique
experience just as he enters all new experiences either with enthusiasm, fear,
caution, resistance or any other manner that is typical of the way he reacts to
new situations The initial contact is of great importance for the success of
the therapy.
It
is during this contact that the stage is set so to speak. The structuring is
demonstrated to the child not merely by words, but by the relationship that is
established between the therapist and the child.
The aim of play therapy is to decrease those behavioral and
emotional difficulties that interfere significantly with a child's normal
functioning. Inherent in this aim is improved communication and understanding
between the child and his parents. Less obvious goals include improved verbal
expression, ability for self-observation, improved impulse control, more
adaptive ways of coping with anxiety and frustration, and improved capacity to
trust and to relate to others. In this type of treatment, the therapist uses an
understanding of cognitive development and of the different stages of emotional
development as well as the conflicts common to these stages when treating the
child.
Play therapy is used to treat problems that are interfering with
the child's normal development. Such difficulties would be extreme in degree
and have been occurring for many months without resolution. Reasons for
treatment include, but are not limited to, temper tantrums, aggressive
behavior, non-medical problems with bowel or bladder control, difficulties with
sleeping or having nightmares, and experiencing worries or fears. This type of
treatment is also used with children who have experienced sexual or physical abuse, neglect, the loss of a family
Children communicate their thoughts and
feelings through play more naturally than they do through verbal communication.
As the child plays, the therapist begins to recognize themes and patterns or
ways of using the materials that are important to the child. Over time, the
clinician helps the child begin to make meaning out of the play. (S. Villeger)
At times, children in play therapy will also receive other types
of treatment. For instance, youngsters who are unable to control their
attention, impulses, tendency to react with violence, or who experience severe
anxiety may take medication for these symptoms while participating in play
therapy. The play therapy would address the child's psychological symptoms.
Other situations of dual treatment include children with learning disorders. These youngsters
may receive play therapy to alleviate feelings of low self-esteem, excessive
worry, helplessness, and incompetency that are related to their learning
problems and academic struggles. In addition, they should receive a special
type of tutoring called cognitive
remediation, which addresses the specific learning issues.
Techniques
Employed In Play Therapy
The basic
principles which guide the therapeutic contacts are very simple, but they are
great in their possibilities when followed sincerely, consistently, and
intelligently by the therapist.
The principles are as follows for the therapist:
The therapist must develop a warm and friendly relationship with
the child.
The therapist must accept the child as she or he is.
The therapist must establish a feeling of permissiveness in the
relationship so that the child feels free to express his or her feelings
completely.
The therapist must be alert to recognize the feelings the child is
expressing and reflects those feelings back to him in such a manner that the
child gains insight into his/her behaviour.
The therapist must maintain a deep respect for the child’s ability
to solve his/her problems and gives the child the opportunity to do so. The
responsibility to make choices and to institute change is the child’s.
The therapist does not
attempt to direct the child’s actions or conversations in any manner. The
child leads the way, the therapist follows.
The therapist does not hurry the therapy along. It is a
gradual process and must be recognized as such by the therapist.
The
therapist only establishes those limitations necessary to anchor the therapy to
the world of reality and to make the child aware of his/her responsibility in
the relationship.
STRUCTURING
The word
structuring is used in this instance to mean the building- up of the
relationship according to the foregoing principles so that the child
understands the nature of the therapy contacts and is thus able to use them
fully. Structuring is not a casual thing, but a carefully planned method of introducing
the child to this medium of self- expression which brings with it release of
feelings and attendant insight. It is not a verbal explanation of what this is
all about, but by establishing the relationship.
The
relationship that is created between the therapist and the child is the
deciding factor in the success or failure of the therapy. It is not an easy
relationship to establish. The therapist must put forth a sincere effort to
understand the child and to check constantly her responses against the basic
principles and to evaluate her work with The relationship that is created
between the therapist and the child is the deciding factor in the success or
failure of the therapy. It is not an easy relationship to establish. The
therapist must put forth a sincere effort to understand the child and to check
constantly her responses against the basic principles and to evaluate her work
with each case so that she too grows in her understanding of the dynamics of
human behaviour.
Desirable Characteristics of the
Playroom
Some
desirable characteristics of the playroom have to be present that are suitable
so that the child can comfortably play within the room. It is desirable to have
a room set aside and furnished for the playroom however, this is not absolutely
necessary. They are vast possibilities of utilizing play therapy techniques
with a very small budget and space appropriations.
Many
psychologists have carried out play therapy in the corner of a regular
schoolroom; some in the corner of an unused nursery with the therapist bringing
the play materials in a suitcase for each meeting. If money and space are
available to furnish a special play therapy room is should have the following
list of things:
The room should be sound proofed if at all possible.
There should be a sink in the room with running hot and cold water.
The windows should be protected by gratings or
screens.
The walls and floors should be protected with
a material that is easily cleaned and that will withstand clay, paint, water,
and mallet attack.
If the room
can be wired for phonographic recordings and provided with a one way screen so
that observations can be made without the child being aware of the observer.
This equipment should be used only for the furtherance of research and as a
teaching aid for student therapists.
The parents do not need to observe the therapy
contacts or listen to the phonographic recordings of the play sessions.
Play
materials which have been used with
varying degrees of success include nursing bottles, a doll family, a doll house
with furniture, toy soldiers and army equipment, toy animals, playhouse
materials, including table, chairs, cot, doll bed, stove, tin dishes, pans,
spoons, doll clothes, clothesline, clothespins, and clothes basket.
A didee
doll, a large rag doll, puppets, a puppet screen, crayons, clay, finger paints
, sand, water, toy guns, pegpounding sets, wooden mallet, paper dolls, little
cars, airplanes, a table, an easel, an enamel top table for finger painting and
clay work, toy telephone, shelves, basin, small broom, mops, rags, drawing
paper, finger painting paper, old newspapers, inexpensive cutting paper,
pictures of people, houses, animals and other objects and empty berry baskets
to smash.
Checker
games have been used with some success but are not the best type of material
for expressive play. Likewise mechanical toys are not suggested because the
mechanics often get in the way of creative play.
If it is not
possible to secure all the suggested materials a beginning can be made by
furnishing a doll family and a few pieces in proper scale, including beds,
tables and chairs, nursing bottles, clay, toy gun, toy soldiers, a toy car,
puppets, a rag baby doll, and a telephone. These materials can be packed in a
suitcase and carried about with the therapist.
Floortime is a play-based technique which
builds on autistic children's own interests or obsessions to develop
relationships and social/communication skills.
The Play Project is another therapeutic
approach which uses play as a tool for building skills in autistic children.
Like Floortime, it builds on children's own interests.
It is possible to be
officially credentialed in Floortime therapy through a certification program
that includes a wide range of content
Sandtray or Sandbox Therapy is a form
of experiential workshop which allows greater exploration of deep emotional
issues. Sandplay therapy is suitable for children and adults and allows them to
reach a deeper insight into and resolution of a range of issues in their lives
such as deep anger, depression, abuse or grief.
Through a safe and supportive
process they are able to explore their world using a sandtray and a collection
of miniatures. Accessing hidden or previously unexplored areas is often
possible using this expressive and creative way of working which does not rely
on “talk” therapy.
"Sand Tray participants are
invited to create a diorama (a story or miniature world) by arranging toy
people, animals, and other items in the sandtray. The therapist evaluates the
participant's choice and use of objects to draw various conclusions about the
subject's psychological health. This non-invasive method works especially well
with those individuals who are young or have trouble comprehending and talking
about difficult issues, such as domestic or child abuse, incest, or the death
of a family member."
Traditional Play
Therapy:
Traditional play therapy is child-centered. The play takes
whatever direction the child chooses. The therapist takes on whatever role the
child assigns. Rather than teaching or changing behavior directly, traditional
play therapy provides a safe environment for the child to act out and release
his or her emotional conflicts.
Cognitive-Behavioral
Play Therapy:
Cognitive-behavioral play therapy follows the same principles as
traditional cognitive-behavioral therapy. It is generally a short-term therapy
with the specified goals of changing the child’s automatic thoughts and
reactions in order to stop the phobic reaction.
In cognitive-behavioral play therapy, the therapist enters into
the play world and gains the acceptance of the child. Once that happens, the
therapist begins to gently guide the play. The toys are used to model different
reactions and teach the child new ways of thinking.
All
playthings should be simple in construction and easy to handle so that the
child will not be frustrated by equipment which he cannot manipulate. Moreover,
they should be durably constructed, designed to withstand strenuous handling in
the playroom. The doll house should be made of light weight wood, with
removable and variable partitions and should be furnished with sturdy wooden
furniture that can be tossed about, bombed, and even stood upon, and still
remain relatively intact. The doll family should be as unbreakable as possible
and outfitted with removable clothes. Very satisfactory doll families can be
made from pipe cleaners, wrapping the pipe cleaners with cotton and securing it
with adhesive tape to give them body. The heads can be made of little cotton
stuffed cloth balls. There should be mother, father, brother, and sister, baby
and grandparents dolls to equip the child with all possible family symbols. The
hand puppets or mitten dolls as they are sometimes called can also be made out
of cloth, using cotton stuffed heads and yarn hair. The puppets too should
include all possible family characters.
A large sand
box serves as an ideal setting in which to place the doll house and family, the
toy soldiers, animals, cars and airplanes. Moreover, the sand is an excellent
medium for the children’s aggressive play. It can be thrown about with comparative
safety. The dolls and other toys can be buried in it. It can be snow, water,
burying ground or bombs. It can readily keep pace with the most elastic
imagination. If the sand box is placed
flat on the floor and has a seat built part way around it, it is more
accessible to children of all sizes than a sand table would be.
If the room
is large enough it is desirable to have a stage built into one end of, with an
elevation of about eight inches. This should be furnished with child- sized
playhouse furniture, which should also meet the standards of durability, thus
giving the children the advantage of having a playhouse unit as well as a stage
for dramatic offerings. The slight elevation is not absolutely necessary but
does have the effect of setting aside the playhouse unit plus it seems to
inspire dramatic efforts. The possibilities of psychodramatics seem worthy of
further research as a medium for therapy.
The
materials should be kept on shelves which are easily accessible to the
children. The writer believes that better results are obtained when all play
materials are a view and the child can choose his own medium for expression
than when the therapist places certain selected materials on the table before
the child and then sits quietly by, awaiting the child s non-directed play.
However some therapists prefer to use a minimum of materials and have observed
interesting results with materials which they have selected for the child.
It is the
responsibility of the therapist to keep a constant check on the materials,
removing the broken toys and keeping the room in order. If the room is used by
several therapists, each one has the added responsibility of seeing that the
playroom is left in order so that one child's play effects will not be
suggestive to the child that follow him. For example if the sand box is used as
a replica of home set up by one subject, it should never be left in a state of
chaos for the next play therapy subject. The paints and clay should be kept
clean and sanitary. If the paint colours become, smeared they should be freshly
mixed. The nursing bottles should be kept sterile. All pictures and clay work
should be removed from the playroom at the end of each session so that the room
is always free from suggestive use of materials.
Due to the
nature of some of the play materials, it is suggested that the child be
provided with a coverall to protect his clothes; this may be furnished either
by the parent or by the therapist. The child should feel free to use the
materials in any way that he desires, within the few limitations that are set
up, without being restricted by a fear of soiling his clothes.
This focuses on using play therapy
with children who are diagnosed with Attention Deficit Hyperactivity Disorder
and Disruptive Behavior Disorders such as Oppositional Defiant Disorder and
Impulse Control Disorder NOS. Emphasis will be placed on learning play therapy
techniques that target the primary symptoms of these diagnoses. In addition,
differential diagnosis and comorbidity will also be addressed. Adjunctive
resources and concrete methods for working with parents and school personnel in
a manner that assists in the generalization of skills learned through play
therapy will also be explored.
ADHD) has
been a significant diagnosis for well over a decade. Kaduson and Finnerty
(1995) conducted a study with sixty-three children between the ages of eight
and twelve. The authors compared three groups of children diagnosed with ADHD
using a game (Self-control Game) for one group, biofeedback for another and a
control strategic game only in the final group. Results indicated biofeedback
was the most effective in improving the child’s self-perception of self-control.
All three groups indicated a significant improvement in sociability and
attention. Peer play therapy groups combined with art therapy groups, and
family play therapy groups combined with art therapy groups, have been shown
(Springer, et al., 1992) to improve depression and hyperactivity scores, in
both boys and girls, according to the ‘Child Behavior Checklist’ in children who have at least one
parent who is suffering from alcohol or drug dependency. Additionally,
aggression and delinquent behaviors significantly decreased in boys. The study
included 132 subjects between the ages of seven and seventeen. Over the past
two decades there has been a concerted effort to develop and implement
well-designed controlled play intervention studies. Two meta-analytic studies
have examined the effectiveness of play therapy with children (e.g., LeBlanc
& Ritchie 1999; Ray, Bratton,
What Does a Play
Therapist Do for Children with Autism?
A good play therapist will get down on the floor with your child
and truly engage him through the medium of play. For example, the therapist
might set out a number of toys that a child finds interesting, and allow her to
decide what, if anything, interests her. If she picks up a toy train and runs
it back and forth, apparently aimlessly, the therapist might pick up another
train and place it in front of the child's train, blocking its path. If the
child responds -- verbally or non-verbally -- then a relationship has begun.
If the child doesn't respond, the therapist might look for
high-interest, high-energy options to engage the child. Bubble blowing is often
successful, as are toys that move, squeak, vibrate, and otherwise do something.
Over time, the therapists will work with the child to build
reciprocal skills (sharing, turn-taking), imaginative skills (pretending to
feed a toy animal, cook pretend skills) and even abstract thinking skills
(putting together puzzles, solving problems). As a child becomes better able to
relate to others, additional children may be brought into the group, and more
complex social skills are developed.
Many parents find they can do play therapy on their own, using
videotapes and books as a guide. Others rely on the experience of trained play
therapists. And still others choose to simply bring their children to a play
therapist or have the therapist come to their home. In any case, play
therapists can provide parents with tools to connect with and have fun with
their children on the autism spectrum.
Children sometimes return to therapy for additional sessions when
they experience a setback that cannot be easily resolved.
Normal results include the significant reduction or disappearance
of the main problems for which the child was initially seen. The child should
also be functioning adequately at home, in school, with peers and should be
able to participate in and enjoy extracurricular activities.
Sometimes
play therapy does not alleviate the child's symptoms. This situation can occur
if the child is extremely resistant and refuses to participate in treatment or
if the child's ways of coping are so rigidly held that it is not possible for
them to learn more adaptive ones.
PLAY THERAPY RESEARCH
AND RESULTS
Play therapy is not an
approach based on guess, trial and error, or whims of the play therapist at the
moment. Play therapy is a well-thought-out, philosophically conceived,
developmentally based, and research-supported approach to helping children cope
with and overcome the problems they experience in the process of living their
lives. Play therapy has been demonstrated to be an effective therapeutic
approach for a variety of children's problems including, but not limited to,
the following areas:
The popular myth that
play therapy requires a long-term commitment for many months is unfounded as is
shown in case studies and research reports reported by Landreth, Homeyer,
Glover, and Sweeney (1996) in their book, Play Therapy Interventions with
Children's Problems
Some examples of problems typically able to be improved and resolved
through child play therapy include
Separation or Divorce – Often
children are greatly affected by the dissolution of their family unit, occasioned by
the separation or divorce of their parents. These circumstances
are sometimes exacerbated by the child being moved frequently from
one residence to another or by being placed in the middle of parental
discourse. This can often be extremely difficult for a child who loves
both parents and does not comprehend all of the complicated issues surrounding
this extraordinary life change. Play therapy will assist children in this
situation to acknowledge their concerns and develop strategies to help them
manage the inevitable stress of these situations, while simultaneously
developing skills that will be relevant and effective throughout their
childhood and into their adult lives.
Life Transitions – Children often have serious
difficulties with transition, whether it be attending a new school, moving to a
new neighborhood, a new home or a
Birth/Adoption of a Sibling or Blending of a Family –
Adding a new member to any family will
certainly offset the balance in the family and can also cause
children significant stress and anxiety. Children may feel insecure and
threatened by the necessity to share attention with the new baby or
children. It is imperative that they are able to pinpoint the root of
their stress, and develop methods to recognize, express and cope with their
feelings. These skills will help them in the immediacy of the situation,
but will also carry forward into their adult lives.
Special Issues Facing Adopted Children – There are often unique issues and challenges which adopted
children face, including fears of abandonment, rejection, detachment, and in
certain cases, issues associated with being from a different culture, looking
and feeling dissimilar from your family, etc. Therapy can help parties address
these concerns directly and can help adoptive parents better understand and
handle these complex and often very painful issues.
Power Struggles/Temper Tantrums
–
While testing limits is a normal part of
childhood, the resulting power struggles can also be a complex and difficult
issue for both parents and children. Therapy can help parents better understand
a child’s desire and need to feel in control and find ways to relinquish and
allow a child to have some control, thus hopefully helping to avoid these
difficult situations. Therapy will also provide the tools necessary to
effectively manage a tantrum should one occur and help parents manage their own
feelings and reactions.
From
a play therapy perspective, there is growing support for combining different
theoretical models in a clinically grounded, integrated manner to address the
needs of children, including those impacted by abuse and trauma (Gil, 2006;
Kelly & Odenwalt, 2006; Kenney-Noziska, 2008b). The emphasis is placed on responding to the
child’s needs versus strict allegiance to one theoretical school of
thought. Being responsive to the child
and adapting the therapeutic approach according to the child’s needs becomes
essential and creates the context from which the therapist operates (Gil,
2006).
As a result, dedicating clinical attention to this area
is an important step. Play-based
interventions can assist in this area.
For
example, the intervention “Ice Breaker”
(Kenney-Noziska, 2008a), a modified version of the game Don’t Break the Ice
(Milton Bradley), provides a play-based medium for the therapist and child to
get acquainted by sharing information about themselves based on the color of
the sticker on the underside of the game’s ice cubes.
Another intervention,
“All Tied Up” (Kenney-Noziska, 2008a), highlights the importance of addressing
and processing abusive and traumatic events using a large puppet or stuffed
animal which is tied up in yarn labeled with symptoms depicted in the
therapeutic story “Brave Bart: A Story
for Traumatized and Grieving Children” (Sheppard, 1998). This serves to symbolize the need to address
symptoms and issues via treatment to avoid being “all tied up.” Until these symptoms are explored and
addressed, the individual remains “all tied up” with the problems.
Emotional Expression
One empirically supported component
in child mental health is providing skills for emotional identification,
processing, & regulation (Saunders, Berliner, & Hanson, 2004). The literature suggests that people who use
words to describe internal states are more flexible & capable of regulating
emotions in a more adaptive way (Siegel, 2007).
It is important to note that many verbal children have difficulty with
words denoting emotions (Knell, 2009) & adolescents often suffer from a
limited feelings vocabulary (Friedberg & McClure, 2002). Subsequently, activities which are geared
toward facilitating emotional expression are essential components of our
work.
Since
many clients avoid discussing distressing emotions, “Revealing Your Feelings” (Kenney-Noziska, 2008a) was developed to facilitate emotional
expression of “hidden” feelings. The therapist uses the “invisible” marker from
the package of Crayola Color Changeable Markers to write various feelings
inside shapes (i.e. squares, circles, triangles, etc.). Players take turns
coloring a shape with one of the Color Changeable Marker, revealing the feeling
word written inside the shape. Each feeling
is discussed and processed.
Feelings Hide-and-Seek” (Kenney-Noziska, 2008a), a
therapeutic version of the childhood game hide-and-seek, is another technique
to facilitate emotional expression. In this activity, feelings are initially
hidden, and through the course of hide-and-seek are found and discussed.
Feelings are written on index cards that are hidden at varying levels of
difficulty around the room. Players take turns finding the hidden feeling cards
and processing a time they experienced the emotion written on the card.
Assessment
and Diagnosis
Treatment planning depends on the accurate
assessment of the child’s development across areas of functioning and an
accurate psychological analysis of the child’s actions during play.
Steward, Farquher, Dicharry, Glick and Martin (1986)
describes a group treatment model for young victims of physical/ or sexual
abuse that is open ended, allowing new group members to begin at any time in
the treatment process. The model utilizes a nondirective play therapy approach
identifies treatment length as 8 months to 2 years. This treatment goals focus
on both healing the wounds of the past and meeting the child’s emotional needs
in the present future.
However a directive approach, with sexually abused
children has been endorsed (Salter,1988& Cunningham1995, Cohen,2009) as a
means of ensuring that trauma issues are specifically addressed in order to
bring about a decrease in symptoms and in the child’s risk of future abuse.
Friedrich(1991) advocates a treatment approach that is specific should be
sensitive to the child’s needs and should emphasize the interpersonal.
Conclusion
Contemporary
play therapy embraces both nondirective as well as directive approaches. Play therapy is far more than mere “play” and
it is essential therapists remain informed of the empirical literature and use
information in their practice. The
emphasis is on using empirical information in a manner which informs the
play-based interventions utilized in practice.
As therapists accompany children and adolescents on their journey of
healing, the incorporation of empirically-informed play therapy interventions
into practice may serve to support the therapeutic process. Child centered play
therapy focuses on the child. Play-based interventions serve to create a
therapeutic process which is developmentally appropriate, engaging, and
effective at addressing many clinical issues.
To accomplish this, interventions utilized must be clinically grounded
and informed by the literature and research which guides the field to serve the
clients. All family members in play therapy interventions are free to work on
specific self-identified problems.