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             Deborah Rogers LMFT


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We can not start to improve until we know who we are.

Self-knowledge is the beginning of self-improvement.

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Clinical Articles





East Bay CAMFT . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .


"Playing With Your Clients: 
  Play Therapy Benefits Children & Families
 by Deborah P. Rogers MFT


Published in "The East Bay Therapist" March/April 2004

A child acts out a story about a small infant who has to sleep on the roof of a pretend house, cold with no blanket, while saying: ďThe baby might fall off during the night.Ē  Another child creates an angry drawing of a house filling with red, roaring flames, and tells a story about how the kids are in the house, dad is asleep and the kids are going to catch on fire.  It is incredible how quickly a child will show you what feelings are circulating inside of themó and inside of their familyóthrough the language of play.

Like the canary in the coalmine, kids have an amazing amount of knowledge about the subtle, and not so subtle, feelings that are present in their family, and they are often able to reveal these things more easily than guarded adults.  This article takes a look at the way in which play therapy with a child can shed light on the issues of their adult parent, benefiting the child, the parent, and the family as a whole.  But first a few words about play therapy itself.

The Language of Children
Children learn about the world through play and they also use play to process their feelings and worries.  Most children would rather not spend too much time trying to talk about their feelings in a cognitive way, but they are quite skilled and comfortable with playing out their feelings.  The therapistís goal is to decode the language of a childís play in order to discover their underlying feelings and needs. Itís actually rather similar to looking for the disguised messages that are found in the symbolic language of dreams.

At first glance, a play therapy session looks rather similar to the regular play activities that you might see a child doing at home: making drawings, playing games, creating songs, playing hide-and-seek, dancing, or story telling.  Depending on the particular therapistís office, the child is often able to choose from a variety of toys, sandtray, drawing supplies, clay, musical instruments, games, puppets, pretend house and miniature figures.  Some activities allow the child to play alone, or in a parallel way with the therapist, and others invite interactive play that is cooperative or competitive.

The biggest difference between regular play and play therapy is the therapistís objective of guiding the child toward processing their difficult feelings, correcting mistaken beliefs, developing healthier outcomes and moving toward healing.  Generally speaking, the play is child-directed.  The child chooses what activity they would like to do.  The therapist paces with the child and narrates some of the play, putting the childís feelings into words, inviting the child to elaborate on things that are happening in the play and to correct any of the therapistís comments that arenít accurate.

When the play therapist listens carefully and makes comments that resonate accurately with the childís feelings, the child will often continue with an elaboration of the story and will give important details about their family experiences.  Children are in the room with you 100% and they very much want you to be in the room with them at this same 100% level.  When children feel accurately understood in a play therapy session, they sometimes let out a sigh of relief and leave the playroom skipping and smiling as if they feel totally free and happy.  What a powerful healing experience to share with them!

A Case Example Ė Benefits Beyond the Child
In session, Marion, a 35-year-old working mother, begins to rattle off a long list of frustrations, with desperation in her voice.  Marion originally entered therapy to work on the conflicts she was having at the office, but now the focus has shifted to the recent, acting out behavior of Daniel, her five-year-old son.  Could Daniel be enacting some of the unspoken tensions that are happening at home?

In addition to continuing her ongoing with Marion, Marionís therapist refers Daniel to a play therapist for a few sessions, and gets permission for the two therapists to discuss the case. This intervention helps to calm things down at home, and it also provides an important new perspective on Marionís own relational conflicts.

So what might play therapy look like with this child?  Themes in the play quickly start to appear.  Daniel insists on acting very bossy in session, tries to tell the therapist what to do and says: ďNo, noÖ you arenít doing it right!Ē  The miniature figures that he plays with are never allowed to make a mistake.  If a figure does make a mistake, the character dies a gruesome death; figures die in the sand tray, they die in puppet play and they die as checker pieces when they are aggressively jumped and knocked off the board.  Anybody that tries to come and help these various figures or game pieces fails repeatedly and ends up feeling hopeless and getting crushed.  Danielís toy physically attacks the helping character and says, ďGo away, you canít help because you will die too.Ē  This child is rarely able to relax and play in a creative and lighthearted way and has trouble tolerating more revealing activities such as drawing a picture of his family or his day at school.

The play therapist begins looking for the deeper source of these
painful, hopeless feelings. What important people or events in this childís life are causing him to feel that there are no solutions?  In the midst of playing out a particularly stressful story, the therapist briefly breaks out of character and asks, ďAnd who in your house has the most rules?  Daniel, now immersed in his feelings, indicates his mother and tells about the time when he felt particularly frustrated and mad.

After a few play sessions, the two therapists discuss their mutual case.  The childís therapist shares information about how the child perceives his mother.  Based on the childís play and his comments about his mother, there appear to be some pretty rigid rules, constant lessons and stressful interactions at home.  Marionís therapist suspects that her adult client is bringing this same rigidity into the workplace, and is causing the very stresses she complains of herself. She brings this new piece of the puzzle into her work with Marion, making connections between Marionís other interpersonal relationships at the office and at home: What is her average level of stress, how rigidly or creatively does she approach problem-solving interactions with others, and what are her beliefs and rules about how a child should behave?

The Healing Process
After Daniel plays out his stressful feelings, with the play therapist seeing and reflecting those feelings clearly, he begins feeling better. In addition, the therapist models appropriate responses as she talks ďforĒ the game pieces and other figures.  Daniel learns that it is OK to have these feelings and also learns appropriate ways to express these feelings to others. In one session the therapist speaks for the dinosaur: ďEvery time I try to go eat some grass, the big lion comes
and pushes me over so I canít eat.  That lion is scary and I donít like it when he hurts me.  Stop hurting me lion! I need to go get some help so I can eat. Iím really hungry.Ē Once Daniel begins to internalize these simple ways of expressing feelings, he begins to apply them at home.  His mother comes in to her session one day and says, ďI was really surprised this week when my son told me that they didnít like it when I yelled at themĒ.  Yes! Another big step toward healthy family communication!

The play therapist invites Marion and her husband to come in for a session by themselves so they can talk about their frustrations in dealing with the acting out behavior as well as talking about the strengths they see in their son.  At another point, she invites the parents to join Daniel in a play therapy session so the family dynamics can be seen first hand.  Are they able to connect with their child through the language of play?  Are they expecting him to act like an adult complying with lots of rigid rules?

Things improve further as the play therapist teaches the parents specific parenting and communication skills.  Marion begins to develop insights about how her rigid parenting style is negatively impacting her child.  Marionís own therapist supports these insights and helps her realize how the same behaviors affect her workplace interactions and relationships with others in the family.  So coordination of interventions between therapists can be quite helpful to the parent, the child and the whole family.

Working with children is very special, with so many profound, healing, unexpected, challenging and funny moments.  There just never seems to be a dull moment when you have the privilege of playing with your child clients... and it can enrich our work with their adult family members as well. 

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California Association for Play Therapy  . . . . . . . . . . . . . . . . . . . . . . . .

"Play Therapy in Australia & Japan"
Insights & Inner Views from the work of Australian play therapist and researcher Dr. Karen Stagnitti
Featuring Columnist,
Deborah Rogers MFT 


Published in "The CALAPT Newsletter" Volume 13, Number 3, Jan 2003


Dr. Stagnitti is a very active Senior Lecturer in Education and Training at the Greater Green Triangle University, Department of Rural Health in Warrnambool, Australia.  In case you arenít that familiar with Australia, Warrnambool is located on the southern coastline, west of Melbourne.  She is also quite dedicated to continuing her research on the importance and success of using play in order to best help children.

Important research findings have been generated by Dr. Stagnitti on the positive impact of using child-initiated pretend play.  These finding were recently published in the January/February 2004 issue of the American Journal of Occupational Therapy.  "Test-Retest Reliability of the Child-Initiated Pretend Play Assessment", was written by she and Dr. Carolyn Unsworth, both from Australia.  Then in March 2004, The Australian Occupational Therapy Journal, volume 51, issue 1, page 3, carried another of Karen Stagnittiís papers on "Understanding Play: The Implications for Play Assessment."  

Karen: So far in my career, the play therapy experiences that I have had are in working with children in Australia and children in Japan.

Deborah: It seems like there might be quite a few differences in play therapy between those two parts of the world! What are some of the
special things that you have noticed?
Karen: From what I have observed during play assessments and in some of my play intervention sessions, I found it interesting that the Australian children showed a wide range of play themes, while the Japanese children did a lot of domestic activities within their play.  As an illustration of this point, I noticed that the Japanese children did not recognize a toy wrench that I have as part of my play materials.  They were much more familiar with the domestic elements of life.  Whereas all of the Australian children easily knew what the toy wrench was.  In Australia, people tend to "do it yourself" whereas in Japan, only certain people know how to fix things because that is their actual
job.

Deborah:
What are some of the most exciting
and valuable elements of sharing play therapy ideas and theoretical approaches cross culturally?
 

Karen: I think it is fascinating to discover the aspects of play that occur across the board in every culture.  I also enjoy finding the unique differences in the childís play that reflect the society that the child is from.

Deborah:
How involved do parents in Australia
become in their childís therapeutic work?  Are there differences between how the mother,
father and extended family participate?
Karen
:
I have noticed that in play intervention sessions, the siblings often joined in and I didnít discourage this as I think it is important that they feel included.  As far as parent participation goes, there was a wide range of responses.  There were parents who were deeply involved and also parents who really didnít see the relevance of play to their child at all.  In my experience, it seemed that motherís tended to be more aware of what the child was capable of than the fathers.

Deborah: How did you become interested in becoming a play therapist?
Karen: My involvement has been from a love of play and an interest in how complex both play and play therapy are.  One of my passions has been to develop assessment tools for play therapy.  I feel that the concept of play would be taken more seriously if it could be assessed more effectively.  To that end I have spent the last few years developing a play assessment tool called "The Child-Initiated Pretend Play Assessment" which so far, is showing good reliability and validity.  From this assessment, I have also developed a play program to help children develop their ability to play.  We have been getting some nice results with children that have Autism and other developmental delays.

Deborah:
What are some of the ways that you would describe your philosophy of how a child heals through the use of play therapy?
Karen: I believe that play is important to a childís development because it encompasses emotional, social, cognitive and language aspects of development.  Play is the natural medium that children use to communicate in their world.  And play is also an important measure of the childís development
.

Deborah:
What do you find are some of the most interesting points about working with children? 
Karen:
I enjoy the fact that playing with children is unpredictable.  You never quite know what is going to happen in a session. It is also very exciting when children start to gain insights regarding their lives and/or develop new skills.  Those are very special times
.

Deborah:
Throughout your career, you must have had many powerful moments that have touched you deeply.
Karen:
Yes, once I saw a child during an Axline session, who let it be know that she didnít like her nickname.  The nickname was something demeaning like Dumbo.  Her Mum had no idea that this was a problem for her daughter.  After the family stopped using this negative nickname, the childís self-esteem improved considerably and interactions with other members of the family improved as well.  Another powerful moment happened with a boy who had Autism.   It was wonderful when this boy finally began to gain skills in his ability to play and was actually able to spend an entire hour in true cooperative play with 4 other boys in the sandpit at his local preschool.  This was a major turning point in his interactions with his peers.

Deborah: What do you feel are some of the important things that play therapists should understand?
Karen: I believe that it is quite important for play therapists to learn how to measure play effectively so they can show the improvements that their child clients make to other professionals that are involved in the case
.

Deborah: What do you see as some of the most common mistakes that play therapists make? 
Karen:
This one is difficult to answer.  Some play therapists feel that what they do isnít as important as other therapies. I believe that this is a mistaken belief.

Deborah:
What are your views on the degree of directiveness that is best in working with a child?
Karen: For children who have no idea how to
play, I am quite directive.  As the child begins to direct his/her own play, I become more nondirective.  In my work, most of the children that I see donít know how to play unless they are
shown.

Deborah: We often invite our clients to
discover various ways to revitalize their lives so they can grow and create health for themselves.  What are some of the things
that rejuvenate you?
Karen: I am fortunate enough to live near a
beach and I find walking on the beach very rejuvenating. I also garden and I enjoy going out to cafes for coffee with friendsÖ I like
that a great deal!

Deborah: We are always looking for new and
interesting ideas of activities to do with our clients.  What have you found to be some of the most powerful techniques in working with a child and their family?
Karen: I have found using pretend play a
powerful technique to use.

Deborah:
What are some techniques for
inviting hesitant children to participate in therapy?
Karen: I have been given a crab puppet,
where the crab is inside the shape of a shell.  The fingers go through the shell section to fingergloves, which pop out of the shell.  The "creature" in the shell can be shy, just like the child, and need encouragement to play.  Also, I sometimes have found that leaving toys out and starting to play with them myself will often encourage a child to join in, since there is no pressure on the child
to do anything.

Deborah:
Overall, what would you say is the
significance of play in regards to mental
health?
Karen: Play allows a child to express who
they are and who they could be.  Play also allows the space that is necessary for a child to explore their ideas and to enter other
worlds.

Deborah: What are a few important points 
that you would like to pass along to other play therapists?
Karen: I would very much like for other play
therapists to know that what they do is so vital to childrenís health and development. 
So, keep on playing!

Many thanks to you, Dr. Stagnitti, for sharing your time and insights with our CALAPT readers.  And appreciation also goes out to our CALAPT past-president, Jessica Stone, for making this interview possible.

 

  TOP  


                                   
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