Play Therapy

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Play Therapy

Definition

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.

Purpose

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.

The use of play therapy relies on the fact that children will process the world in a way that is different from the adult approach. Some researchers describe two stages of function for children at the elementary school level: the “preoperational stage” (ages 2 to 7 years) and the “concrete operations stage” (ages 8 to 11 years). In the preoperational stage, children are still learning how to use language, which employs symbols (words) to mentally represent the things in their world. They tend to have rigid thinking processes, limited only to what is before them, without digging more deeply. Because this results in a lack of true understanding of the world around them, they will provide their own explanations, employing “magical thinking.” The child’s play, as a result, will increasingly employ imagination and fantasy as he or she ages. Adults who can understand how the play and fantasy translate from a child to an adult world can interpret the child’s language.

Play therapy thus relies on the fact that the language of children, especially very young children, is play. Play also serves several other roles for children that can be used in the process of play therapy, including providing a sense of control and a way to develop coping skills. A skilled play therapist will be able to make the most of these factors in using play therapy as a way to translate the child’s communications.

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, nonmedical 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 member, medical illness, physical injury, or any experience that is traumatic.

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 incompetence that are

MELANIE KLEIN (1882–1960)

The Austrian psychotherapist and child psychologist Melanie Klein developed methods of play technique and play therapy in analyzing and treating child patients. Raised in a Jewish middle-class family, she lacked both the academic background and the medical training usually found in those who choose psychoanalysis for a profession. She was a married woman with children when she began undergoing analysis about 1912. During her analysis she began to observe the behavior of a disturbed child relative and to interpret this behavior in the light of her own psychoanalytic experience. Her analyst, recognizing his patient’s aptitude, encouraged her in her efforts at child therapy, a hitherto neglected area.

Originally trained as a Freudian psychoanalyst, Klein made observations and conclusions regarding child behavior that led her to views differing from those held by orthodox Freudian psychoanalysts. She was one of the first to engage in child analysis, beginning in 1920. She evolved a system of play therapy to supplement the usual psychoanalytic procedure, perhaps because the age of her clients indicated more appropriate methods than the exclusively verbal free-association technique then used with adult patients. Gradually she evolved a technique more suitable for probing the deep-layered recesses ofthe child’s mind. By providing the child with small toys representing father, mother, or siblings, she was able to elicit the child’s subconscious feelings. Her technique also used the child’s free play and his spontaneous communications.

Her first paper, “The Development of a Child,” was presented to the Budapest Congress of Psychoanalysis in 1919, the year in which she became a member of the Hungarian Psychoanalytic Society. In 1921 she went to the Berlin Psychoanalytic Institute as the first child thera-pist.In what has been called her second period, beginning in 1934, Klein theorized her previous observations on child behavior, arriving at conceptual conclusions based on them. She wrote now of her earlier findings, on the “depressive position” and the “schizoid-paranoid position,” indicating possible ways in which these infancy states relate to psychotic processes in adults.

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.

Precautions

Play therapy addresses psychological issues and would not be used to alleviate medical or biological problems. Children who are experiencing physical problems should see a physician for a medical evaluation to clarify the nature of the problem and, if necessary, receive the appropriate medical treatment. Likewise, children who experience academic difficulties need to receive a neuropsychological or in-depth psychological evaluation in order to clarify the presence of a biologically based learning disability. In both of these cases, psychological problems may be present in addition to medical ailments and learning disabilities, but they may not be the primary problem and it would not be sufficient to treat only the psychological issues. Alternatively, evaluations may show that medical or biological causes are not evident, and this would be important information for the parents and therapist to know.

Description

In play therapy, the clinician may meet with the child alone for sessions or with a parent present, and may arrange times to meet with parents separately, depending on the situation. In some forms of play therapy, the therapist may observe the child at play with the parent. The structure of the sessions is maintained in a consistent manner to provide a feeling of safety and stability for the child and parents. Sessions are scheduled for the same day and time each week and occur for the same duration. The frequency of sessions is typically one or two times per week, and meetings with parents occur about two times per month, with some variation. The session length will vary depending on the environment. For example, in private settings, sessions usually last 45 to 50 minutes while in hospitals and mental health clinics the duration is typically 30 minutes. The number of sessions and duration of treatment varies according to the treatment objectives.

During the initial meeting with parents, the therapist will want to learn as much as possible about the nature of the child’s problems. Parents will be asked for information about the child’s developmental, medical, social, and school history, whether or not previous evaluations and interventions were attempted, and the nature of the results. Background information about the parents is also important since it provides the therapist with a larger context from which to understand the child. This process of gathering information may take one to three sessions, depending on the style of the therapist. Some clinicians gather the important aspects of the child’s history during the first

meeting with parents and will continue to ask relevant questions during subsequent meetings. The clinician also learns important information during the initial sessions with the child.

Sessions with parents are important opportunities to keep the therapist informed about the child’s current functioning at home and at school and for the therapist to offer some insight and guidance to parents. At times, the clinician will provide suggestions about parenting techniques and about alternative ways to communicate with their child, and will also serve as a resource for information about child development. Details of child sessions are not routinely discussed with parents. If the child’s privacy is maintained, it promotes free expression in the therapist’s office and engenders a sense of trust in the therapist. Therapists will, instead, communicate to the parents their understanding of the child’s psychological needs or conflicts.

For the purposes of explanation, treatment can be described as occurring in a series of initial, middle, and final stages. The initial phase includes evaluation of the problem and teaching both child and parents about the process of therapy. The middle phase is the period in which the child has become familiar with the treatment process and comfortable with the therapist. The therapist is continuing to evaluate and learn about the child, but has a clearer sense of the youngster’s issues and has developed, with the child, a means for the two to communicate. The final phase includes the process of ending treatment and saying goodbye to the therapist.

During the early sessions, the therapist may talk with the child about the reason the youngster was brought in for treatment and explain that the therapist helps make children’s problems go away. Youngsters often deny experiencing any problems. It is not necessary for them to acknowledge having any since they may be unable to do so due to normal cognitive and emotional factors or because they are simply not experiencing any problems. The child may be informed about the nature of the sessions, specifically that he or she can say or play or do anything desired while in the office as long as no one gets hurt; what is said and done in the office will be kept private unless the child is in danger of harming himself.

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. This is important because the play reflects issues which are important to the child and typically relevant to their difficulties.

When the child’s symptoms have subsided for a stable period of time and when functioning is adequate with peers and adults at home, in school, and in extracurricular activities, the focus of treatment will shift away from problems and onto the process of saying goodbye. This last stage is known as the termination phase of treatment and it is reflective of the ongoing change and loss that human beings experience throughout their lives. Since this type of therapy relies heavily on the therapist’s relationship with the child and also with parents, ending therapy will signify a change and a loss for all involved, but for the child in particular. In keeping with the therapeutic process of communicating thoughts and feelings, this stage is an opportunity for the child to work through how he or she feels about ending therapy and about leaving the therapist. In addition to allowing for a sense of closure, it also makes it less likely that the youngster will misconstrue the ending of treatment as a rejection by the therapist, which would taint the larger experience of therapy for the child. Parents also need a sense of closure and are usually encouraged to process the treatment experience with the therapist. The therapist also appreciates the opportunity to say goodbye to the parents and child after having become involved in their lives in this important way, and it is often beneficial for parents and children to hear the clinician’s thoughts and feelings with regards to ending treatment.

Preparation

It is recommended that parents explain to the child that they will be going to see a therapist; that they discuss, if possible, the particular problem that is interfering with the child’s growth and that a therapist is going to teach both parents and child how to make things better. As described earlier, the child may deny even obvious problems, but mainly just needs to agree to meet the therapist and to see what therapy is like.

Aftercare

Children sometimes return to therapy for additional sessions when they experience a setback that cannot be easily resolved.

Normal results

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, and with peers,

and should be able to participate in and enjoy extracurricular activities.

Abnormal results

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.