What is Play Therapy and how is it therapeutic?

NOTE: This article is from The Therapeutic Powers of Play by Charles E Schaefer

Play, like love, and happiness is easier to recognize than to define. One does not have to pressure or motivate a child to play by giving external rewards. Rather, play seems to satisfy an inner desire in the child. The play process is more important than the end result. Positive feelings accompany play. These pleasurable feelings are derived from the play activity itself and are a result of the play. Such feelings of enjoyment are evident in the smiles, laughter, and joy exhibited by children during and just following the play. There is always some variation in play, and often creativity and innovation result. Play tries to answer the question, ”What can I do with this object?”

INITIAL CONTACT
Adequately preparing your child for the therapy appointment is critical in reducing resistance. When children are ill-prepared, much anxiety, mistrust, and anger are created. To avoid this, I have a few suggestions on preparing the child for the first appointment. The following suggestions may be helpful:

1. Be honest and open.
2. Inform the child at least three days before the appointment of the day, time, length, and place. This provides the child enough time to prepare, but limits the amount of time anxiety can be generated.
3. Discuss the reasons for the appointment.
4. Inform the child that the therapist will talk to both the child and parent and the child will also play with some toys.
5. Tell the child that no medical procedures will be performed, such as blood work or shots. It is hoped that by utilizing these suggestions initial resistance can be prevented or minimized.

The first goal in child therapy is to draw the child into a working alliance. Most children do not come voluntarily to therapy, deny they have problems, and are wary of talking to a strange adult in an unfamiliar office.  Usually they do not feel troubled, but they are troublesome to those around them. They tend to view therapy as a punishment and expect criticism from the therapist rather than support. Play seems to be the best way to establishing rapport and alliance with a child since it is a behavior that is interesting, enjoyable, and natural to children. Once rapport is established the child will be more likely to commit to therapy and agree to work towards needed change.

Play is to the child what verbalization is to the adult – the most natural medium for self-expression. Play is a special form of communication. It is primarily nonverbal and constitutes a language quite different from verbal language. Play is a more fantastic, drive-dominated form of communication that is full of images and emotions. It seems more right-brain oriented than the logical, sequential, and analytic thought expressed in words, which seems more left-brained centered. Clearly, play provides a window into the otherwise invisible inner world of the child.

A warm, accepting, respectful therapist creates a playroom atmosphere of safety, devoid of threat. Within such a climate the child can examine and solidify his sense of self. According to Rogers, self-realization comes from feeling accepted, respected, and esteemed. Children who feel rejected, on the other hand, tend to respond to the lack of a warm relationship with defiance, aggression, and withdrawal. A number of studies have connected an affiliative therapeutic relationship with improved clinical outcome.

THE ROLE OF THE THERAPIST IN PLAY    The role of the child therapist encompasses a wide range of functions and duties. First and foremost is engaging the child in therapy. This occurs when the child becomes invested and is committed to change. The key to working with resistant children is establishing this alliance.

A second function involves observing the child’s play and assessing the underlying themes and dynamics.   A Many different types of themes will surface, such as abandonment, rejection, aggression, power/control, and loneliness. The difference between well-adjusted and disturbed children is not in the content of themes, but in the quality of the play and intensity of the themes. Disturbed children are unable to modulate emotion, and become highly aroused. In addition, the play of disturbed children is much more variable and unreliable than that of well-adjusted children.

COMBINING PLAY AND THERAPY  Play, in itself, is not therapy. For play to be therapeutic it needs to have definite qualities. Six therapeutic uses of play have been defined by Amster (1982): First, play provides opportunities for diagnostic. It enables them to deal with emotionally charged material, by providing an outlet for emotional discharge. In addition, it lets children act out unconscious material through symbolism.  Last, play has a developmental significance in preparing children for future life events.

GAME PLAY:  Children begin playing board games at about age 5 or 6, and this interactive pay increases in frequency during elementary school years and remains stable during the adult years. Since games involve rule-governed behavior, ego control must be stronger than impulse-driven behavior. Game play also prepares children for their roles in the social world, including both competitive and assessment. Valuable information about a child’s social and emotional functioning is gained through play. An inability to play suggests severe emotional disturbance. Second, play helps develop a working relationship between the child and the therapist. It provides an enjoyable and natural setting that affords intense interpersonal interaction. Third, play assists in breaking down defenses. Children lack the defense mechanisms present in adults, and their egos easily regress, thereby allowing their rich fantasy life to surface. Fourth, play facilitates verbalization. It creates the distance necessary so that children can talk about traumatic events. Fifth, play provides a cathartic release.  Seeing the immediate consequences of one’s actions in a game develops a sense of an inner locus of control of the environment, the challenge inherent in games help overcome feelings of boredom and dullness.

ART THERAPY ASSESSMENTS AND THE USE OF ART IN THERAPY
Art has been used as a means of self-expression for centuries. People have used art materials to “make images and connect them to feelings and bodily states that bring into the open thoughts that have been only vaguely sensed.” (Keys, 1083, p.104)  Drawing exists as a parallel to verbal language and was the simplest of nonverbal languages.  Art does not have the restriction of linguistic development in order to convey thoughts or feelings.

I use  art as part of my assessments. The HUMAN FIGURE DRAWING TEST is designed to determine developmental level as well as provide information on personality characteristics.

KINETIC FAMILY DRAWINGS (“draw me a picture of your family doing something”) was designed to address the limitations of static family drawings by adding a kinetic component (action). The therapist can gather information about family dynamics as well as the child’s adaptive and defensive functioning.

KINETIC SCHOOL DRAWING (“draw me a picture of you doing something at school”) produces another view of the child’s life. Discussion can bring out details of the child’s life at school.

HOUSE TREE PERSON TEST (HTP) is designed to provide information on personality characteristics and interpersonal relationships and interactions with the environment.

KINETIC HOUSE TREE PERSON TEST:  (KHTP) Used to interpret the developmental stages of the person, tree, and house images.

SANDPLAY THERAPY
Sandplay is a nonverbal, non-rational form of therapy that reaches a profound preverbal level of the psyche’. Sandplay enables the three-dimensional tangible expression of the unconscious. Sand pictures represent figures and landscapes of the inner and outer world.  Sandplay helps with the expression of a damaged self and enables the repair of injuries to the self. Children have fun searching through my drawers to find just the right figures and objects for their “sand picture” and then are able to use their words to explain what they were trying to say with the figures.  By moving the sand away from the bottom of the tray, one gets the impression of blue water, which can then serve as a river, lake or ocean.  Because of the waterproof lining of plastic, real water can be used to wet the sand so that it can be molded or shaped to express things that are difficult to explain with words.

Using sand tray, the patient is free to play out fantasies, to externalize and make concrete in three dimensions his or her inner world. You choose an object; you put it back. You become more aware of a feeling. The tray becomes an extension of yourself. You know what feels right to put into it. If it doesn’t feel right, you take it out. It makes your feelings accessible to you, helps you to distinguish them. It tells you you have a feeling, whether you’re celebrating a something or a nothing.