Non-Directive Play Therapy - Essay Example

Case study: Non-Directive Play Therapy Introduction: Play therapy is a relatively new concept to be adopted by the professionals as a therapeutic intervention. The increasing use of play as a therapeutic process is mainly due to the requirement of a large number of children and youngsters who need effective and efficient strategy to be treated. Professionals dealing with the psychological and emotional wellbeing of children and young people are completely aware of the severity that may be enabled if such children are not treated properly and thoroughly. Play therapy creates a slow but more thorough and deep relationship between the child and the therapist. This relationship calls for a change in the way the children perceives things and ends up creating a more successful person in the future. Play therapy is different in a way that it normally provides a safe, trusting, soothing and pleasurable environment to the child under consideration. The result of creating such a climate is the trust of the child in the therapist. The more the individual feels comfortable the easier it gets to understand his problem and solve it accordingly. Play therapy, hence, directs toward a one-to-one relationship where children are encouraged to communicate and express their feelings, fear, views and thoughts. Therapists normally get two kinds of communications from the children, that is, either the children communicate their issues and feelings directly in words (Wilson et. al., 2002) or indirectly by using actions and behaviors. Whatever way the child chooses, a therapist must respond to the messages, either direct or indirect, that he receives from the children. Therapists are required to listen, understand and respond to the children in a way which they feel is suitable for that particular child. The therapists must keep in mind that their behavior and responses would play a significant role in the development of a future relationship between them and the children. They need to flourish the relationship and must respond in a way which strengthens the relationship rather than creating any negative feeling or perception in the child’s mind. The underlying theory is to develop command of children over the feelings which are hidden and controlling them. Non directive approach to play therapy was formed by Axline who gave a way to professionals through which they could treat children. The basic principles laid down by Virginia Axline revolve around non directive play therapy and how a therapist could successfully follow these guidelines. The principles basically revolve around the concept of self realization by children. Axline guides the therapist to follow an approach which would help the children to overcome their difficulties themselves. Virginia gave eight principles with regard to non directive play therapy. The first principle given by Axline revolves around the strength of the relationship between the therapist and the child. Axline tells that the therapist should be close enough to the child that he gains his trust and confidence. Secondly the therapist should not be biased towards the child or have a stance which would affect the judgment of the child. Axline in the rest of the principles states that the children should be secure enough with the therapist so that they can readily discuss everything with the therapist. A successful non directive play therapy would have all these factors together so that the children feel comfortable in the environment. In the sessions of therapy Axline also proposes that the therapist be careful when assessing the child. Even the non verbal modes of communication by the child can be picked up by the therapist and used in such a way that the emotions in the preconscious of the child are grabbed. Axline’s principles are very important when talking about non directive play approach as they can help the therapist and child to get together in such a way that they can openly discuss things. By these discussions it can be ensured that the children come to terms with life as the therapist would present with solutions to the problems of the children (Axline 1989; Telford. R. & Ainscough 1995). The child that I had to handle was M.P who was a five year old girl. Non directive play therapy was important to guide her in life as she had gone through an accident which made her nervous and shy. The non directive play therapy carried out by me would follow all the principles laid down by Axline in such a way that the girl came to terms with life as it was now. Non directive play therapy was necessary for that girl as she was having problems in life. Non directive play therapy would ensure that I get close enough to the girl to discuss her problems. I had to undergo different sessions with her so that I could understand her problem so that I was able to propose solutions to her. Moreover with the principles laid down by Axline it was easy for me to get close to the child so that I could know her better. In order to have a close look at her life I had meetings arranged with her mother so that I could know more. I underwent twelve sessions with the child so that I could boost up her morale and encourage her to get over that accident. I developed a close relationship with the child so that I could make her speak in front of me. I gave her a perfect environment as put by Axline so that the child could be comfortable enough (Axline 1989). In this report I would further elaborate the sessions I had with the child and her family. I would tell as to how non directive approach in play therapy can be helpful in treating children who are suffering from problems. Therapies can be really helpful if followed with the right principles and they can treat children who otherwise cannot be treated. These therapies are nowadays also used for adults so that they can get over the problems faced in life (Axline 1989; Telford. R. & and Ainscough 1995). Child’s Introduction: The name of the child under consideration is M.P. M.P. was born on 2/9/2010. She is a 5 year old girl with an unremarkable past medical history and normal development. She was brought under my surveillance by her parents. They were more concerned to keep her spirits high and strengthen her progress in all areas of life. The play therapy worked really well with M.P. and the cooperation from parents and meetings with them also helped in achieving the success of this therapy. M.P.’s own interest and friendly nature was a big benefit in the rapid development of therapeutic process. First Meeting With the Mother: In order to get more knowledge about the child’s problem and her personal life a meeting with her mother was arranged. This was the first meeting and provided the basic understanding of M.P.’s life and behaviors. The information gathered from this meeting indicates that the child’s personal life is simple and straight. The child lives with both parents and her grandmother. She is the youngest of the 4 children. She has 2 brothers and a sister. The child has a special relationship with her father. She also has a very good relationship with all other family members. She attends a kindergarten at present and at home she is a very active child. She wants to involve in everything. Her relationships and activities show her contentment and satisfaction with her life. Apparently there is nothing wrong with the child’s family life and social circle. The mother appeared to be satisfied with her nature, behavior and growth (Wilson & Wilson 2000). Reason for Referral: M.P. was referred by her parents who were concerned about her confidence and inner strength after she met an accident. In February 2009, she had accidently stuck her hand in a machine. As a consequence of this accident she lost the middle three fingers of her right hand. Her parents were worried about child’s self-confidence and morale as they found some instances of shyness, embarrassment and hesitation after M.P. lost her fingers. The parents reported in the initial meeting that they observed M.P. hiding her hand when she was in public during the last couple of weeks. In addition, the mother reported that the child now scares to stay alone (Axline 1986; Wilson & Wilson 2000).. Parents’ Expectations of Play Therapy: Parents were worried for their child’s growth, confidence and development problems that may arise due to the consequences of accident. Parents brought their child to assure her development and growth both physically and psychologically without any influence of the humiliation or sense of misery. They expected the following as a result of the child going to play therapy sessions: 1) Increase her self-confidence 2) Accept the present situation (after the accident) 3) Not to hide her hand when in public. 4) Overcome her fears. Flow of the Therapeutic Process: Session 1 M.P. during the first session seemed a bit nervous and appeared feeling uncomfortable in the play room. The child watched closely and listened to me as I described the playroom and the descriptions of materials and environment we had. I then talked about when she would come to see me and how many times and for how long. She showed interest to explore the room and the toys. She explored the clay for a few minutes and also spent some time evaluating the musical instruments. However, she spent almost half of the session playing in the sand tray. In her first sand tray she used several wild animals and grouping of the same species was observed during this activity. The whole tray was used by the child and all the figures were placed within the boundaries of the tray. There was no clear indication of a trouble spot. The child mainly placed them in the sand tray creating a picture without playing with them. Also the child played a lot with kitchen toys and the baby dolls, during this activity pretend play was observed. The child showed an attentive behaviour towards the baby doll while role playing the mother. The child asked several times to help her do something or placing a toy, a possible indication that she is not yet comfortable using her hand because of the missing fingers. The child shares readily the toys with me and likes me to engage in her play. A warm and friendly relationship was created with the child. My initial thoughts and feelings are that the child needs help to built her self esteem, express her feelings and accept the present situation (i.e. after the accident). (Tuner 2005; McMahon & McMahon 2009). Session 2 During this session, the child played for few minutes with the sand tray, showing again interest in the wild animals, but she just placed them in the sand tray without playing with them. She used only one part of the tray this time. The child also spent few minutes in drawing. She used yellow, orange, black and blue paint creating only circles. She still had difficulty to write or draw with her left hand, but she tried very hard. During this session, she also played with the play dough having the whole quantity in front of her, cutting small pieces and giving them to me. The child through this activity can learn cooperation by sharing and turn taking. Most of the session, the child was playing with the first aid kit and the dolls pretending to be the mother that took her baby to the doctor. As an initial reaction, after seeing the medical equipment, she was more interested in observing them and asked several questions about their use. In the last few minutes she played a bit with a doll without expressing any feelings or thoughts. She pretended that the child was sick (i.e. having high fever), and she showed great interest and attentive behaviour as a mother towards her baby. She also mentioned that the baby “scares in the hospital”, but then changed activity without giving me the opportunity to explore her emotions further. In order to make her feel comfortable I told the child that “I try not to ask children what they want to talk about and what they want to do in the play room, because I know that people keep asking you many questions about what you feel about certain things. I will work with you, I will try to help you and if you want to talk about anything just tell me about it, but if you don’t want to, that’s all right as well. You have as much time as you need for yourself”. Some of the problem areas of M.P’s life were touched on, and she explored, in a way, her feelings about the accident and her experience with the doctors, showing her need to externalise her feelings. I think that was a great initial reaction through pretend play to express in following sessions her feelings regarding her trauma. Also, while talking during the session I asked who gave her a sticker that she had on her t-shirt, and she answered “a friend of mine from the school, and he is dead now”. When I asked what happened she didn’t answer and after a while she said “all my friends at school are dead”. I was not sure how to react so I chose not to say anything and discuss the incident with my supervisor. We discussed that probably children at school excluded her from their play, or they might have asked questions about her hand making her feel inferior and/or angry. The only way for her to “disappear” them is to convince herself that they are dead, they are absent from school that’s why they don’t play with her. It is important for a therapist to form hypotheses about the meaning of the child’s thoughts in order to understand and respond to it better, but these explanations were never shared with the child (Turner 2005; Oaklander 1988; Axline 1986). Session 3 Today the child seemed very tired and rotten. She did not pay particular interest in any of the toys. She only played a bit with the first aid kid, the dolls and the doll house. Pretend play was observed, but no communication at all (verbal or non verbal) with me throughout the session. I ensured her that this is her special time and she can do whatever she wanted to do and think whatever she wanted (McMahon & McMahon 2009). Session 4 The child today appeared very happy and full of energy. She spent some time in drawing corner using almost all the colour pencils to do a scribble. In my opinion a very important developmental stage for the kid that it will help her to link her drawings to the world around her and her emotions. Even though children at this age usually like to talk about their drawings and create stories about them, M.P. chooses not to discuss anything regarding her drawing. Then the child played with the doll house, placing mainly the furniture in the house and decorating the house, while talking with me about her 2 friends at school that they do not want to play with her. I had a conversation with the child to help her find ways to handle the situation. The most important part of the session was while playing with the first aid kid and the dolls. The child seemed to project herself to the doll where in the child’s play the doll was in great pain because she had an accident and injured her hand. She “was bleeding, she was in great pain and scared”. That was a break-through for the child who has not addressed the traumatic event until the day of the specific session. M.P’s play, although speaking in role, the therapist accepts the child’s choice of symbolic activity and responds within the metaphor used by the child, without interpretation (Wilson & Wilson 2000). Session 5 The child today spent almost the whole session in the sand tray using wild and domestic animals. She again placed them in groups of similar species, using the whole tray, but this time she mentioned couple of times that she placed a specific animal with one similar to it because they are friends. What comes to my mind is her need to have friends who accept her as she is, even with her disability; a need to prove that she is similar with all the other kids and needs to be part of the group too. While she played she disclosed that she did not have a good day at school because no one wanted to play with her. Therapeutic environment in the play room, gave the child space in which to explore feelings of fear, anger and loss, and probably most of all rejection. M.P. seemed to feel safe in the play room now. She allowed me to approach her emotionally, and shared her thoughts and feelings with me. It seemed throughout the session that her self esteem is improved a lot too (Wilson & Wilson 2000). Session 6 The child today was sick and seemed quite tired. She did not have the energy to play or show particular interest to the toys, even though she played with the dolls, the kitchen toys and the first aid kid. She appeared to be a slow mover with sleepy movement being dominant. She did not communicate with me at any point of the session. She also spent some time drawing. She scribbled using red, green, orange, brown and black colour, one connected with the other and around was a part of red colour and a green colour. The most dominant colours were black, red and green. Is the red colour a representation of anger and her need for affection from a significant person? Does green colour imply that the play room is a place to escape from anxiety and return to an untroubled nature? Can the black colour be associated with the child’s unconsciousness, depression and/or loss of her fingers? The therapist formed hypotheses to herself about meaning of M.P’s drawing and play in order to understand and respond to it better, but these explanations were never shared with the child (McMahon & McMahon 2009; Wilson & Wilson 2000). Session 7 The child today seemed not to concentrate enough while playing. She did not interacte/communicate with me throughout the session. She played the whole session with the kitchen toys and the dolls where she was cooking and taking care of the baby. She was very sweet and caring towards the baby doll. A lot of pretend play and role play (as a mother) was observed. The child today asked me several times for help to do something throughout the session. Session 8 The child today was very calm throughout the session. She spent the whole session playing with the dolls and the first aid kid. Half of the session she performed the role of the mother of the baby, where she was taking care of the baby, fitting it, playing with her etc. The other half of the session she played the role of the doctor towards the sick baby. She was very sweet and caring towards the baby, encouraging the baby girl not to be afraid because she will get well soon. The child seemed to develop her play comparing with the previous sessions, and also her ability to communicate seemed to improve a lot. She started to initiate a conversation with me and share her thoughts and feelings mainly regarding her relationship with her friends (Wilson & Wilson 2000). Session 9 The child appeared to feel safe and calm in the play room. She again spent almost the whole session playing with the dolls and the first aid kit. Similar behaviour was observed like the previous session. The child disclosed that she feels unhappy because one of her friends “doesn’t love her and doesn’t want to play with her”. At the beginning of the session lack of descriptive speech was observed, mainly when I asked her how was school and how she spent her week. She used short sentences without any meaning. Also the child’s ability to draw from memory seemed very limited. Session 10 The child today appeared relax and seemed to feel safe with me in the play room. She spent the whole session with the first aid kit and the dolls, where she was playing the role of the doctor and I was playing the role of the mother as she asked me. She was very sweet and carefully treated the baby who “injured his hand and was bleeding and crying” as she said. The therapist reflected M.P’s thoughts/feelings which she was experiencing. Although, speaking in role, the therapist was thus “explaining” or interpreting in a very basic sense, M.P’s feelings to her. However, with a non directive approach beyond this basic sense of interpretation, the therapist accepts the child’s choice of symbolic activity and responds within the metaphor used by the child, without interpretation. The non threatening therapeutic environment enables the child during symbolic play to assimilate personal experiences freely. Her face and expressions were calm throughout her play time. The child communicated a lot with me throughout the session. She did not mention directly anything about her hand or her experience in the hospital yet, but she appeared to have good memories regarding the doctors and the whole experience in the hospital according to her play. Also the child’s self confidence seemed to improve a lot. She was telling me what to do, she decided what we shall play and she verbally communicated with me much better than before (Wilson & Wilson 2000; Turner 2005). Session 11 The child today was very enthusiastic to come to the play room. She spent almost the whole session playing with the kitchen toys and the dolls, where she was their mother and preparing food for them, giving them milk, put them to sleep etc. She wanted me to involve in her play throughout the session. The child seemed to develop her self confidence a lot, using a lot her injured hand without paying any attention to it or trying to hide it from me. The child communicated a lot throughout the session. Session 12 Today it was a very interesting session with the child. While she was drawing, nothing specific, just used paints to do different shapes, she told me about “her problem”. She disclosed that “I cut my three fingers in a big machine”. I reflected that and the child said “I was scared but now I am fine”. I ensured her that it is fine sometimes to feel scared, because we all are scared about some things and that she is completely capable of doing everything even though her three fingers were missing. She agreed with me and continued her drawing. The child needed repeated opportunities to talk about the situation although it was often too overwhelming to put into words her feelings. She seemed calm and her facial expressions and her body seemed relaxed. “Art and play gave opportunities for these confused feelings…to be expressed and perhaps eventually verbalized” (Book: “Working with children in art therapy” p.131) While playing with the puzzles she appeared very confident that she could do it all alone and she wanted me just to watch her doing it without any help. In previous sessions she kept asking for my help to do almost everything. The child began to demonstrate a more positive self-image as our sessions progressed. In the end of the session, she chose to leave her drawings with me in our “treasure box”. What might have been done differently: Session 2 – I had to reflect the child’s thoughts about her “dead friends” so I would help her to get an insight into her thoughts and feelings and help her to externalized them. Conclusions: After the sessions clearly signs of progress could be seen in the actions of the child. She started behaving quite right while she used to play games and grew confident about herself. In other words she identified her qualities and became self-confident. All these signs were noticed during her daily life routine such as her actions in school and house. She was reported to become normal again in all her activities including her responses and social interaction at home and at school. The therapist further took notice of the changes in the behaviour of M.P’s behaviour during the sessions and it was also noticed that she underwent a drastic change in other areas of life. It was however analyzed by therapist that some areas of M.P’s life were still untouched and she still faced problems. She still could not stay alone in the room where the accident occurred. In my view the child should be given more time with her feelings and should be let alone at that place for more time so that she can get used to it (Axline 1986; Turner 2005). Through symbolic play (use of first aid kid and dolls) : With the developing sessions it was seen that the child was growing confident when expressing her views about the accident. She began to relax and share her views about the accident and the after-reaction by other individuals who saw her. She emphasized on the fact of rejection by other children at school. As the sessions progressed it was seen that the child began to have a more positive about herself. References Axline, Virgina. Play Therapy. London: Churchill Livingstone, 1989. Telford. R. & and Ainscough, K. (1995) "Non-Directive Play Therapy and Psychodynamic Therapy." British Journal of Occupational Therapy. 58 (5) WILSON, K., KENDRICK, P., & RYAN, V. (2002). Play therapy: a non-directive approach for children and adolescents. London, Bailliere Tindall. Axline, V. M. (1986). Dibs: In search of self. New York: Ballantine Books. Oaklander, V. (1988). Windows to our children. Highland, NY: Center for Gestalt Development Inc. McMahon, L., & McMahon, L. (2009). The handbook of play therapy and therapeutic play. London: Routledge. Ryan, V., Wilson, K., & Wilson, K. (2000). Case studies in non-directive play therapy. London: J. Kingsley. Turner, B. A. (2005). The handbook of sandplay therapy. Cloverdale, Calif: Temenos Press. Read More