Is There a Best Play Therapy for the Client - Essay Example

Is There a Best Play Therapy for the Client? The different types of play therapy, while they many be based on different psychological theories and the may have a few different techniques, have one thing in common, they are effective in relieving symptoms according to the research to date. 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. The therapists choose the techniques that have been proven to work with the child’s identified symptoms. It does not seem that the therapist chooses a different theory based on the issue with which the child presents, but it does seem necessary that the therapist know what mechanism of change is necessary and incorporate those into their treatment plan. Research Says Play Therapy is Effective 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. The Premise of Play Therapy 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. This covers not only communication but emotional regulation, relationship development, self image, appropriate choices and self-actualization. Eclectic Approach The eclectic approach to play therapy seems to keep the symptoms of that particular child foremost in the decision making of the therapist. It would seem that since most theories work then the questions is are there particular techniques that work best for a particular symptom. This is treatment specificity. An example of choosing a technique from a particular therapy would be if the parent needed to learn parenting skills adding the parent to the therapy as is done in Filial Play Therapy would facilitate the needs of that particular client while the rest of the play therapy could be what that therapist would usually do with that child’s symptoms. 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). It would seem that the eclectic therapist could integrate the unique parts of this therapy to fit the needs of the family with which she is working. Since this writer favors this eclectic approach, the reader must understand that this approach requires a strong assessment process before beginning. The therapist must know what symptoms need attention so that the techniques that deal with that are chosen. The therapist must stay up to date on the science of the therapy to know what the outcome studies are showing to be effective with any given therapy and with any given therapeutic technique. The therapist must remain a scientist and know the research and makes decisions about the therapy plan from a scientific bases (Shaefer, 2003). Shaefer (2003) also notes that the therapist must understand therapeutic change to make decisions about what should be involved in the therapy to fit the individual. This is an “if… then” way of looking at relationships within a model of therapy. The therapist must understand that if this is done then this is the result. This seems like a wise way of looking at treatment planning from this writer’s perspective. The therapist then knows the symptoms, since she has done a very complete assessment, and she is able to look at the “if…then” model to know what needs to be implemented to improve that symptom. The therapist should be able to answer the question “Why have your chosen this treatment plan?” by saying outcome studies show that if the client has this symptom then it will improve when we do this. This is known as understanding therapeutic change mechanisms. Using this type of eclectic approach which included good assessment of the child, strong scientific knowledge of outcomes and change mechanisms and writing a treatment plan specific to each child’s symptoms seems to refute what Shaefer (2003) calls the dodo method of applying play therapy. It is clear that all theories of play therapy work but certainly certain components of each are better for a specific symptoms than are others. I looking at the history of play therapy development it seems that each theory is first tested as to its efficacy. Then it is further applies to a specific diagnosis and/or a specific symptom. As early as 1974, McDernott and Char found that play therapy was especially effective for abused and neglected children as long as the play materials were appropriately chooses. They then realized the process was more effective if the parents were involved in the process. So they began with largely influenced by the person centered approach of Axline. She 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 (1974). Terr (1979) developed play therapy for children with psychic trauma or post traumatic stress disorder. This was a combination of psychodrama and Axline’s original play therapy. There have been play therapy adjustments for the cross-gender child, aggressive children, Borderline children and mentally retarded children. All of these therapies began with a theory and make adjustments in techniques and even play materials to get a better “if…then” understanding of the process (Shaefer, 2000). It seems to this writer that it comes down to preferences and training of the therapist indeveloping an excellent treatment plan for each patient. There is no question that play therapy is effective and it is clear that one size may work with all but certainly using the pieces that are most effective in specifying areas is better therapy. But it does not end there; each therapist must continue to educate herself in the science of the therapy. What shows the best outcomes. Not just what type of play therapy show the best outcomes but what therapeutic mechanisms of change show the best outcomes with what symptom. Researchers must continue to study details so that play therapy continues to get better and be prescriptive for each child. The therapist must gather the pieces and put the puzzle together. Therapy done properly involves excellent assessment and diagnosis, specific treatment planning and a strong up to date background in the field. That is true of all kinds of therapy and play therapy is no exception. References 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. McDermott, J.F., & Shar, W.F. (1974). The Undeclared War Between Child Psychiatry and Family Therapy. Journal of the American Academy of Child Psychiatry, 13, 422-439. 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. Schaefer, C   (2003)   Foundations Of Play Therapy   John Wiley & Sons   Terr, L. (1979). Children of Chowchilla: A study of Psychic Trauma. Psychoanalytic Study of the Child, 34, 457-623. 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. Read More