Empowering Techniques of Play Therapy

Griffith, M. (1997). Empowering Techniques of Play Therapy: A Method for Working with Sexually Abused Children. Journal of Mental Health Counseling. 19 (2), 130-42.

This article, like many others, begins with a brief survey of play therapy theory. It is remarked that play is the natural medium of expression for children and that sexual abuse seems to block many basic developmental needs. Treatment goals are outlined and plotted along a pattern which the process of therapy follows. A case study is provided to articulate these points and exemplify the "five stages" of play therapy. These stages are the establishment of the therapeutic relationship, the later exploratory stage (in which regressive and repetitive behaviors often appear), the limit-setting stage (in which the child tests the boundaries and safety of the therapeutic setting), the growth stage (see below), and the termination stage. Treatment goals in the growth stage involve confronting the "four characteristics of sexual trauma" which are sexual traumatization, stigmatization, betrayal, and powerlessness. Sexual traumatization can lead to confusion between sexuality and affection, confusion about sexual norms, age-inappropriate sexual knowledge, and sexual behavior. It is believed that through the use of empowering techniques of play therapy (expressive/imaginative play and non-direction), the emotional distress of sexual abuse can be relieved and normal psychological development can resume.

Play therapy with sexually abused children

Hill, A. (2006). Play therapy with sexually abused children: Including parents in therapeutic play. CHILD AND FAMILY SOCIAL WORK. 11 (4), 316-324.

According to this article, situations in which sexual abuse has increased a child's separation anxiety can often be improved by including parents in play therapy. This allows the child to feel more secure in his/her primary attachment relationships, while presenting the often confused and uncomfortable parents with a positive model of interaction to emulate. It may also be beneficial for the therapist to witness and interact in the parent-child relationship which, if strained, can often exacerbate the trauma. It is noted that parents benefit from participating in the therapy by eliminating feelings of exclusion and jealousy they may have developed in response to the new therapist-child relationship, by countering feelings of guilt and failure in the role of parent/protector common to situations of child abuse, and by rebuilding confidence in their parenting abilities.

Possible complications of introducing parents into child therapy are discussed. Issues of the child's privacy and confidentiality are naturally raised, as well as the possibility that some parents might be unwilling to participate or counter-productive in the process. Suggestions or interventions by the therapist may be viewed as criticism by the parent.

Two case studies are provided to exemplify these points and to illustrate the situation of a child expressing anger towards his/her parents in response to sexual abuse (by someone else). While this is a common occurrence in play therapy, it becomes complicated when that parent is present. Lastly, it is noted that including parents in play therapy can counteract the "dynamic of secrecy" often imposed on the sexually abused child by the abuser.

Play Therapy with Sexually Traumatized Children

Kelly, M. M. (1995). Play Therapy with Sexually Traumatized Children: Factors That Promote Healing. Journal of Child Sexual Abuse. 4 (3), 1-11.

This article begins with a survey of play therapy theory, with special attention given to various writer's takes on the merits of directive vs. non-directive approaches. It is argued that the treatment of sexually abused children often involves a series of "resolution cycles" characterized by the alternation of active work and periods of respite. Each of these cycles comprises three phases: testing the therapeutic relationship, readdressing the trauma, and protective distancing and denial. Another cycle will then be initiated only if there is trust and respect between the child and the therapist. Cycles can take as long as four or more sessions to complete, or may play out in the course of a single session (as is common in the beginning stages of therapy).

Two case studies (one with a 7 year old girl and another with an 8 year old boy) are provided to illustrate the progression of such cycles and to show that the denial phase usually occurs when the child's personal resources are exhausted. It is argued that a clear understanding of these cycles can furnish a therapist with more realistic expectations when working with sexually abused children.

Play Therapy With Abused Children: A Review of the Literature

White, J., & Allers, C. T. (1994). Play Therapy With Abused Children: A Review of the Literature. JOURNAL OF COUNSELING AND DEVELOPMENT. 72 (4), 390.

This article gives an overview of play therapy, identifies and explores seven characteristic behaviors exhibited by abused children, identifies and explores two general themes of play in abused children, and critiques play therapy research. The characteristic behaviors are developmental immaturity, opposition and aggression, withdrawal and passivity, self-deprecating and self-destructive behavior, hypervigilance, sexual behavior, and dissociation. The recurrent themes of play behavior are unimaginative/literal play and repetition/compulsion. Each of these behaviors and themes are elaborated on and special attention is paid to the differences between the behaviors exhibited by sexually abused, physically abused, and neglected children. Lastly, contemporary research is critiqued for its inconsistent definitions, nonstandardized methodologies, and flawed statistical designs.