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.
Showing posts with label Children. Show all posts
Showing posts with label Children. Show all posts
Tuesday, March 11, 2008
Monday, March 10, 2008
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.
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.
Friday, March 7, 2008
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.
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.
A case study using child-centered play therapy approach to treat enuresis and encopresis
Cuddy-Casey, M. (1997). A case study using child-centered play therapy approach to treat enuresis and encopresis. ELEMENTARY SCHOOL GUIDANCE AND COUNSELLING. 31 (3), 220-225.
Enuresis (bedwetting) and encopresis (bed-defecation) may come from one or more of the following causes: medical-genetic disorders, emotional disturbances, and failure to learn. Depending on the main cause, different treatments are used. Physicians are usually called to deal with the organic problems underlying medical-genetic disorders, while behavioral techniques are used to treat problems stemming from a failure to learn. However, problems rooted in emotional disturbances are commonly lumped into the "failure to learn" category and treated thusly. This article argues for an alternative treatment (i.e. non-directive play therapy) to be used in response enuresis and encopresis rooted in emotional disturbances.
A case example is provided in which an 8-year old male with enuresis and encopresis is treated with play therapy after medical-genetic disorders and failure-to-learn are ruled out. In these sessions, the child began to exhibit aggressive behavior and admitted to wanting to destroy the playroom's pictures and wall clock, which he believed to have cameras hidden behind them. After this admission was received with the permissiveness and acceptance that are the hallmarks of non-directive therapy, the child also admitted that he did not use public restrooms because of this fear of hidden cameras. He spent the next few sessions searching the playroom for cameras and, upon not finding any, began to have less and less problems with enuresis/encopresis.
Enuresis (bedwetting) and encopresis (bed-defecation) may come from one or more of the following causes: medical-genetic disorders, emotional disturbances, and failure to learn. Depending on the main cause, different treatments are used. Physicians are usually called to deal with the organic problems underlying medical-genetic disorders, while behavioral techniques are used to treat problems stemming from a failure to learn. However, problems rooted in emotional disturbances are commonly lumped into the "failure to learn" category and treated thusly. This article argues for an alternative treatment (i.e. non-directive play therapy) to be used in response enuresis and encopresis rooted in emotional disturbances.
A case example is provided in which an 8-year old male with enuresis and encopresis is treated with play therapy after medical-genetic disorders and failure-to-learn are ruled out. In these sessions, the child began to exhibit aggressive behavior and admitted to wanting to destroy the playroom's pictures and wall clock, which he believed to have cameras hidden behind them. After this admission was received with the permissiveness and acceptance that are the hallmarks of non-directive therapy, the child also admitted that he did not use public restrooms because of this fear of hidden cameras. He spent the next few sessions searching the playroom for cameras and, upon not finding any, began to have less and less problems with enuresis/encopresis.
Wednesday, March 5, 2008
Jungian Play Therapy in Elementary Schools
Allan, J., & Brown, K. (1993). Jungian Play Therapy in Elementary Schools. Elementary School Guidance and Counseling. 28 (1), 30-41.
This article discusses the Jungian approach to play therapy and provides a case study to exemplify its methods. As a (or perhaps the) proto-humanistic psychologist, Jung believed that growth and transformation are the main drives in the psyche. Thus, counseling involves mainly providing a safe and protective setting in which these internal processes can propel a child into change. This so-called self-healing archetype requires a healthy connection between the child's conscious and unconscious worlds. Therapy is thus also aimed at creating such a connection.
Jungian play therapy identifies three major themes or stages through which a child's play evolves: chaos, struggle, and resolution. It is through the progression of this resolution that the ego develops a sense of control and mastery as it learns to mediate the "struggle of opposites." Towards the end of therapy, common themes become construction, reparation, and healing.
Jungian play therapy is directive in its counseling style and makes use of interpretation interventions to "deepen affective expression." This is received much more positively by the child if it is initiated after a strong therapeutic relationship of rapport is established. This point and others are illustrated in the case study of a third grader with aggressive behavior problems. His sand play had a recurrent theme of "good guys" struggling against "bad guys." When, later in therapy, this theme was interpreted as analogous to his own feelings of isolation and confliction, he accepted it and showed remarkable change in the next session. In the next sand world he made, there was a fenced off area where kids could go and nothing could happen to them. It is argued that this opportunity to release his feelings allowed the child's positive, integrating mechanisms to guide him to growth, and that the direct interpretations expedited this process.
This article discusses the Jungian approach to play therapy and provides a case study to exemplify its methods. As a (or perhaps the) proto-humanistic psychologist, Jung believed that growth and transformation are the main drives in the psyche. Thus, counseling involves mainly providing a safe and protective setting in which these internal processes can propel a child into change. This so-called self-healing archetype requires a healthy connection between the child's conscious and unconscious worlds. Therapy is thus also aimed at creating such a connection.
Jungian play therapy identifies three major themes or stages through which a child's play evolves: chaos, struggle, and resolution. It is through the progression of this resolution that the ego develops a sense of control and mastery as it learns to mediate the "struggle of opposites." Towards the end of therapy, common themes become construction, reparation, and healing.
Jungian play therapy is directive in its counseling style and makes use of interpretation interventions to "deepen affective expression." This is received much more positively by the child if it is initiated after a strong therapeutic relationship of rapport is established. This point and others are illustrated in the case study of a third grader with aggressive behavior problems. His sand play had a recurrent theme of "good guys" struggling against "bad guys." When, later in therapy, this theme was interpreted as analogous to his own feelings of isolation and confliction, he accepted it and showed remarkable change in the next session. In the next sand world he made, there was a fenced off area where kids could go and nothing could happen to them. It is argued that this opportunity to release his feelings allowed the child's positive, integrating mechanisms to guide him to growth, and that the direct interpretations expedited this process.
The Masterson Approach with Play Therapy
Mulherin, M. A. (2001). The Masterson Approach with Play Therapy: A Parallel Process between Mother and Child. AMERICAN JOURNAL OF PSYCHOTHERAPY. 55, 251-272.
This article illustrates the principles of the Masterson Approach with a long-term case study involving a child and his mother in adjunct therapy. The Masterson Approach (with which I am not very familiar) is a psychodynamic developmental self and object relations approach. It involves providing opportunities for diagnostic assessment, developing a working relationship within therapy, assisting in the breakdown of defenses, facilitating verbalization, providing cathartic release, and preparing the child for future life events. As will be seen, the diagnosis has a large effect on which treatment strategies are deemed appropriate.
The initial diagnosis for both the mother and son was distancing borderline disorder. As a result, the technique of confrontation was used as intervention. However, as confrontation led to increased anxiety in both patients, the diagnosis was changed to schizoid disorder of the self and interpretation of the schizoid dilemma became the primary therapeutic technique. This seemed to have drastic effect, as both patients responded positively. The new diagnosis was thus confirmed.
An interesting aspect of this case study was the enmeshment, or parallel progression of the mother and son. Often the son would act out (in his sand trays) the very same conflicts his mother struggled with in her verbal therapy. They both exhibited signs of the splitting defense mechanism, with the son accepting his mother while rejecting his father, and the mother having panic attacks as she fantasized about reuniting with her separated husband.
Two interesting events in the play therapy are also worth noting. First was when the son explicitly acknowledged the symbolic nature of his play by remarking (after destroying one of his sand worlds) that he was glad those "bad feelings [were] gone". And second was when the creation of a loss/death-themed sand world in his fifth year of treatment seemed to usher in a much more integrated child. After this cathartic experience, his regressive defenses completely disappeared.
This article illustrates the principles of the Masterson Approach with a long-term case study involving a child and his mother in adjunct therapy. The Masterson Approach (with which I am not very familiar) is a psychodynamic developmental self and object relations approach. It involves providing opportunities for diagnostic assessment, developing a working relationship within therapy, assisting in the breakdown of defenses, facilitating verbalization, providing cathartic release, and preparing the child for future life events. As will be seen, the diagnosis has a large effect on which treatment strategies are deemed appropriate.
The initial diagnosis for both the mother and son was distancing borderline disorder. As a result, the technique of confrontation was used as intervention. However, as confrontation led to increased anxiety in both patients, the diagnosis was changed to schizoid disorder of the self and interpretation of the schizoid dilemma became the primary therapeutic technique. This seemed to have drastic effect, as both patients responded positively. The new diagnosis was thus confirmed.
An interesting aspect of this case study was the enmeshment, or parallel progression of the mother and son. Often the son would act out (in his sand trays) the very same conflicts his mother struggled with in her verbal therapy. They both exhibited signs of the splitting defense mechanism, with the son accepting his mother while rejecting his father, and the mother having panic attacks as she fantasized about reuniting with her separated husband.
Two interesting events in the play therapy are also worth noting. First was when the son explicitly acknowledged the symbolic nature of his play by remarking (after destroying one of his sand worlds) that he was glad those "bad feelings [were] gone". And second was when the creation of a loss/death-themed sand world in his fifth year of treatment seemed to usher in a much more integrated child. After this cathartic experience, his regressive defenses completely disappeared.
Tuesday, March 4, 2008
Play therapy; the troubled child's self-encounter
Hyde ND. (1971). Play therapy; the troubled child's self-encounter. The American Journal of Nursing. 71 (7), 1366-70.
A general overview with anecdotal examples of non-directive play therapy from a psychiatric nurse. The article quotes largely and effectively from the major players (Axline, Moustakas, etc.). There is not much here that you can't get from the primary texts themselves, but it is not bad either. It outlines the theoretical framework of non-direction, permissiveness, and attentiveness on the part of the therapist. It also acknowledges the projection, darkness, and struggle for integration evident in children's play.
A general overview with anecdotal examples of non-directive play therapy from a psychiatric nurse. The article quotes largely and effectively from the major players (Axline, Moustakas, etc.). There is not much here that you can't get from the primary texts themselves, but it is not bad either. It outlines the theoretical framework of non-direction, permissiveness, and attentiveness on the part of the therapist. It also acknowledges the projection, darkness, and struggle for integration evident in children's play.
An experiment with play therapy
Smith LF. (1977). An experiment with play therapy. The American Journal of Nursing. 77 (12), 1963-5.
A summarized and anecdotal account of an amateur play therapist (nursing student) working with a withdrawn child. Only very limited dialogue is provided, more often utilizing descriptions of what actions and conversations took place. This article is another case study to read, but without dialogue and given the inexperience of the therapist, it leaves much to be desired as a learning tool. The child in this case study expressed his anxiety in an obsession with cleanliness, spending much of the time cleaning the windows and walls of the playroom. He also played extensively with a customizable doll house, deconstructing and reconstructing it, and had the therapist act out his own daily routines.
A summarized and anecdotal account of an amateur play therapist (nursing student) working with a withdrawn child. Only very limited dialogue is provided, more often utilizing descriptions of what actions and conversations took place. This article is another case study to read, but without dialogue and given the inexperience of the therapist, it leaves much to be desired as a learning tool. The child in this case study expressed his anxiety in an obsession with cleanliness, spending much of the time cleaning the windows and walls of the playroom. He also played extensively with a customizable doll house, deconstructing and reconstructing it, and had the therapist act out his own daily routines.
Using play therapy in outpatient settings
Meer PA. (1985). Using play therapy in outpatient settings. MCN. The American Journal of Maternal Child Nursing. 10 (6).
This article demonstrates the ambiguity existing in terms such as "play therapy" in research contemporary to it. What is described here is toys being used by nurses in calming children and preparing them for medical procedures, which is very different from the play therapies used by professional therapists in building permissive and accepting relationships with "troubled" children.
Aside from this rather frustrating catachresis, the article describes the interesting application of play-related concepts to children in health care settings. Specifically, puppets and dolls can be used to familiarize children with the equipment and procedures they will later be exposed to. Allowing children to participate in this play-acting can make them feel more control over the situation, assuaging some of their anxiety and leading to an overall feeling of independence.
This article demonstrates the ambiguity existing in terms such as "play therapy" in research contemporary to it. What is described here is toys being used by nurses in calming children and preparing them for medical procedures, which is very different from the play therapies used by professional therapists in building permissive and accepting relationships with "troubled" children.
Aside from this rather frustrating catachresis, the article describes the interesting application of play-related concepts to children in health care settings. Specifically, puppets and dolls can be used to familiarize children with the equipment and procedures they will later be exposed to. Allowing children to participate in this play-acting can make them feel more control over the situation, assuaging some of their anxiety and leading to an overall feeling of independence.
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.
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.
Use of the telephone in child play therapy
Spero MH. (1980). Use of the telephone in child play therapy. Social Work. 25 (1), 57-60.
A brief exposition of the use and benefits of supplying a toy telephone in child play therapy settings. Spero begins by remarking that a toy is only as useful in a therapeutic context as the child's willingness to play with it. Thus, despite the potential goldmine of communication in a toy telephone, this is wasted unless the child decides to use it. Having said this, he continues on to highlight the potential uses the toy telephone might be to. A child may hold a conversation with an imaginary party, fantasize a connection with the deceased or unavailable, or even exercise projection by assuming the role of both parties. Four brief case studies are provided to illustrate these potential uses. It is remarked that children will often pretend to phone their therapist (early in therapy) in an attempt to form a connection with them, and that the act of forcibly hanging-up can be a powerful way for reserved children to learn to express their desires and frustrations.
A brief exposition of the use and benefits of supplying a toy telephone in child play therapy settings. Spero begins by remarking that a toy is only as useful in a therapeutic context as the child's willingness to play with it. Thus, despite the potential goldmine of communication in a toy telephone, this is wasted unless the child decides to use it. Having said this, he continues on to highlight the potential uses the toy telephone might be to. A child may hold a conversation with an imaginary party, fantasize a connection with the deceased or unavailable, or even exercise projection by assuming the role of both parties. Four brief case studies are provided to illustrate these potential uses. It is remarked that children will often pretend to phone their therapist (early in therapy) in an attempt to form a connection with them, and that the act of forcibly hanging-up can be a powerful way for reserved children to learn to express their desires and frustrations.
Play therapy: the children's views
Carroll, J. (2002). Play therapy: the children's views. CHILD AND FAMILY SOCIAL WORK. 7, 177-188.
A qualitative study on children's reactions to non-directive play therapy. Interview questions pertained to how the children felt about their introduction to play therapy, their relationship with the therapist, the therapeutic processes, their likes and dislikes in therapy, and the termination of their therapy. Children's responses varied greatly, but several basic themes emerged. Notably, while children universally enjoyed their relationship with the therapist greatly, they were largely unable to pinpoint what aspects of the therapist's behavior were most helpful. The children appreciated the provisions of food at the beginning of therapy and described their sessions as being importantly "fun". Many seemed to dislike explicit "talking about their feelings". This is a truly fascinating project, but unfortunately only a small sample size was acquired. More research on this is needed.
A qualitative study on children's reactions to non-directive play therapy. Interview questions pertained to how the children felt about their introduction to play therapy, their relationship with the therapist, the therapeutic processes, their likes and dislikes in therapy, and the termination of their therapy. Children's responses varied greatly, but several basic themes emerged. Notably, while children universally enjoyed their relationship with the therapist greatly, they were largely unable to pinpoint what aspects of the therapist's behavior were most helpful. The children appreciated the provisions of food at the beginning of therapy and described their sessions as being importantly "fun". Many seemed to dislike explicit "talking about their feelings". This is a truly fascinating project, but unfortunately only a small sample size was acquired. More research on this is needed.
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