Which Play Therapy is Best - Case Study Example

Which Play Therapy is Best? The use of play in therapy was first experimented with, by early child therapists. Anna Freud (1928, 1964, 1965), Margaret Lowenfeld (1935, 1970) and Melanie Klein (1961, 1987) believed in the use of play, for example, Klein (1961, 1987) said that a childs spontaneous play was a substitute for the free association used within adult psychoanalysis. Theories and practice surrounding play differ within each Child Psychotherapy tradition. However, each tradition shares a main belief that play communicates the childs unconscious experiences, desires, thoughts and emotions. By studying all of these traditions, one finds that they are all useful or most types if childhood issues. In the 1940s, Carl Rogers (1951, 1955) established a new model of, person centered therapy. Emphasis was placed on the relationship between therapist and client based upon genuineness, acceptance and trust. Person centered theory provided a new perspective of personality structure, psychological health and the process of change in therapy. Largely influenced by the person centered approach, Axline (1969, 1971) developed a new therapeutic approach for working with children - non directive Play Therapy. Based on the person centered theory, Axline devised a clear Play Therapy theory and method. She said "No-one ever knows as much about a human beings inner world as the individual himself. Responsible freedom grows and develops from inside the person". Her eight principles of the therapeutic relationship are still followed today. None of them pertain to a particular type of issue or child but to all children in need of therapy. For over 50 years, Play Therapy has been practiced and researched within the United States. This has been led by many Play Therapists, including Moustakas (1953, 1966, 1973, 1981, 1992) and Schaefer (1976, 1986, 1993), who have progressed Axlines original formulations and devised differing models integrating elements of systemic family therapy, narrative therapy, solution focused therapy and cognitive behavioral therapy. Play Therapy started to emerge as a new and differing tradition in the 1980s. Since then, the Childrens Hour Trust has taught professionals the basic techniques of Axlines Play Therapy that are used in a multitude of settings. As play therapy developed it was still applicable not only to all children but in numerous setting. British Drama Therapists started using Play Therapy methods to enhance their Drama Therapy with children. Sue Jennings (1994) and Ann Cattanach (1993, 1994, 1998) integrated parts of non directive Play Therapy to enlarge the British Play Therapy movement. Play Therapy emphasizes the client as trustworthy. Play Therapy is based upon three critical theoretical principles: Actualization - Humans are motivated by an innate tendency to develop constructive and healthy capacities. This tendency is to actualize each persons inner potentials, including aspects of creativity, curiosity and the desire to become more effective and autonomous. The Need for Positive Regard - All people require warmth, respect and acceptance from others, especially from significant others. As children grow and develop, this need for Positive regard transforms into a secondary, learned need for positive self regard. Play as Communication - Children use play as their primary medium of communication. Play is a format for transmitting childrens emotions, thoughts, values and perceptions. It is a medium that is primarily creative Research on Efficacy of Play Therapy Play Therapy research has investigated a range of issues, including clinical effectiveness, parental involvement and the analysis of specific techniques. Kot (1995) investigated the effectiveness of non-directive Play Therapy with child witnesses of domestic violence. Outcome measures were compared against a control group and evaluated using the Joseph Pre-School and Primary Self-Concept Screening Test, Child Behavior Check List and Childrens Play Sessions Behavior Rating Scale. Children in the treatment group were found to have significantly reduced externalizing behavior problems and significant reduction in their total behavior problems. This study used a total of 20 subjects with ages ranging from 3 years to 10 years. Springer et al (1992) investigated the effectiveness of Play Therapy and Art Therapy with children identified as having one parent suffering from alcohol or drug dependency. A total of 132 subjects were used with ages ranging from 7 years to 17 years. Results indicated subjects within the treatment groups experienced significant improvements in depression, hyperactivity and disruptive behavior (identified by Child Behavior Check List). Dogra and Veeraraghavan (1994) found that children diagnosed with aggressive conduct disorder who received 16 sessions of non-directive Play Therapy sessions and Parental Counseling sessions showed significant improvement in their behavior. Using the Picture-Frustration Test and Child behavior Rating Scale as a measure, the treatment group showed a significant positive change to self, home, school, social, physical and personality on adjustment. Aggression in the experimental group was also reduced, showing reductions in fighting, bullying, violence against adults, obedience and temper tantrums. This study involved 20 subjects with ages ranging from 8 years to 12 years. Ray et. al. (2001) completed a meta-analysis of 94 research studies investigating the clinical effectiveness of Play Therapy. The 94 studies measured the effects of Play Therapy conducted by mental health professionals in America and contained 3263 subjects (mean age=7.1 years). Experimental design was used for each of the 94 studies. The 94 studies investigated the effectiveness of Play Therapy with different client groups. A total of 20 client groups were investigated, including difficulties such as Conduct Disorder, Anxiety/Fear, Speech and Language Difficulties, Depression, Sexual Abuse and Post Traumatic Stress Disorder. The results of the meta-analysis conducted by Ray et al (2001) revealed a large effect size (d=.80). The authors concluded that Play Therapy is an effective intervention for a broad range of childrens difficulties. The consistent conclusions from these studies are that abused children improved significantly from the use of play therapy. Children of alcoholics are less depressed and have a higher self esteem after play therapy. This play therapy included the use of art. Children with aggressive behaviors improved significantly with play therapy. This play therapy was paired with therapy for the parents. Finally a meta-analysis concluded the play therapy is and effective intervention for a broad range of children’s issues such as Conduct Disorder, Anxiety/Fear, Speech and Language Difficulties, Depression, Sexual Abuse and Post Traumatic Stress Disorder. Notice how the research moves from older to newer and continues to show the success of play therapy even as play therapy continues to develop and change. Differing Techniques Filial Play Therapy differs in that it involves the parents in the play so the parents grow and learn as the child improves so this therapy is a bit specific to the child if the parents also need help in parenting. The therapy then can help the child understand their feelings better and they become more capable of expressing their feelings in appropriate ways. The child learns to communicate their needs to the parents and they are reassured the parents will help with problem solving. The child also becomes a more capable problem solver on their own, coming up with more appropriate responses to their feelings and needs. In turn, all of these successes reduce inappropriate behaviors, increases the child’s trust in the parents and the child’s self esteem becomes healthier, increasing his/her self confidence. This type of therapy is helpful to teach the parents how to form a closer bond with their children and how to form happier family relationships. The parent learns to understand the child’s concerns and feelings better. They learn parenting skills to facilitate better cooperation from the child. The parents learn new ways to listen to what the child is telling them and they learn communication skills that are effective with their child. This parent training helps them to develop more confidence in their parenting ability so they can deal with the frustrations of family life more easily. Further, the parents learn to trust their children as well as themselves ( Myrow, 2006). This type of therapy is unique in its approach, but note, that it has been found to be effective in most areas of childhood concern. The techniques only seem to matter to the therapists the results seem to be all the same. There seem to be several techniques that are being used in Gestalt Play Therapy. They use internal dialogues where the child just says out loud what they are thinking with out interruption or interpretation. This is also done in journals for older children. So the child may be painting or playing gin a sand box but they say everything they think out loud(Shaefer 2000). The child may be involved in role play so they can experience some of the things they may never dare to do otherwise. A very shy child may be asked to role play a leadership role for example (Shaefer 2000). They may also be asked to participate in an exaggerated behavior. This allows the child to experience in reality what they thought they were experiencing. This helps the child learn to interpret body language and the behavior of others more accurately. It also helps the child become aware of their own body language (The Association of Play Therapy, The Effects of Client-Centered Play-Therapy). The Gestalt therapist may also have the child play out their dreams. They believe each event in the dream represents and inconsistency in the child’s understanding of their interpretations of the hear and now (The Association of Play Therapy, A Comparison of Three Play Therapy Theories). The therapist wants the child to identify if they are more task oriented or people oriented through their play. Often sand play therapy helps the child to see this by the choice of figures they choose to play with. This then has an influence on the child’s behavior that the child must learn to understand (Shaefer 2000) . The therapists also seem to be concerned about the child’s learning style. This involves understanding the child’s creativity in play and in acting out situations. The therapist may use sensory awareness techniques such as touch and smell. These techniques help the child be more aware of their emotions and thereby more in control of their emotions. It is important for the child to be aware of their environment to be aware of the hear and now. To accomplish this they may have the child do peeping through fingers, looking around through a tube, looking through colored paper or looking in mirrors (The Association of Play therapy, A Comparison of Three Play Therapy Theories) Researchers have shown that this type of therapy can be applied successfully to therapy with children with different types of emotional problems to improve their self-support and self-esteem (Polister 1974). This writer could go on to talk about different kinds of play therapy but the point is that they all seem to be very effective. They seem to work in multiple locations and with the majority of issues with which children present. Filial Therapy adds the parent component. It appears to this writer that the kind of therapy will very with the therapist chosen. Each therapist seems to utilize what works best for them and what represents there personal theory about play therapy. It does not seem that the therapist chooses a different technique based on the issue with which the child presents and it does not seem to matter what that issue is as play therapy has been shown to be consistently effective across the gamete of childhood issues regardless of the techniques used. References Association of Play Therapy. The Effects of Client-Centered Play-Therapy. Retrieved July 27, 2007 from http://www.a4pt.org/abstracts. Association of Play Therapy. A Comparison of Three Play Therapy Theories. Retrieved July 27, 2007 from http://www.a4pt.org/abstracts. Dogra, A., & Veeraraghavan, V. (1994). A study of psychological intervention of children with aggressive conduct disorder. Journal of Clinical Psychology, 21, p. 28-32. Kot, S. (1995). Intensive play therapy with child witnesses of domestic violence. Denten Texas: University of North Texas. Myrow, D. L. (2006) Theraplay : An Introduction. British Journal of Play Therapy. (2), 14-23. Ploster, E. (1974). Gestalt Therapy Integrated. New York: Vintage Books. Schaefer, C.E. (Ed). (2000). Handbook of Play Therapy. New York: John Wiley. Ray, D., Bratton, S., Rhine, T., & Jones, L. (2001). The effectiveness of play therapy: Responding to the critics. International Journal of Play Therapy, 10(1), p. 85-108. Springer, J.F., Phillips, J., Phillips, L., Cannady, L., and Kerst-Harris, E. (1992). CODA: A creative therapy program for children in families affected by abuse of alcohol or other drugs. Journal of Community Psychology, p. 55-74. 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