Play is important for the child’s holistic development including their physical, language, social, emotional and cognitive development. Play allows children to learn naturally from the world around them to gain life skills and understanding Play allows children to freely explore the world around them, without adult direction. Play allows the child to create, challenge, imagine, engage and explore satisfying activities for both themselves and others. Children may use equipment; play alone or with others, in energetic or calm manner. Play is a vital component for a child’s development and lives and is essential to be promoted where possible (Play England, 2007).
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Play is the primary and natural medium of communication for children (Axline, 1947). Children may not have the capacity to use words to express themselves, but with the assistance of play therapists, communication and understanding can occur between both the child and therapist. As children do not have the same abilities to communicate and express themselves verbally and as effectively as an adult can, play gives children the opportunity to express their emotions and experiences. This can provide a foundation to build relationships with the play therapist and others, allowing their needs and requirements to be known and to gain a better understanding of themselves (Landreth, 2002).
Play therapy then, is a medium of therapy in which play is used, to observe children engaging in play. By providing resources of play materials and knowledge of theory around play therapy, therapists can identify and examine the child’s underlying issues.
Wilson & Ryan, (2005) state that the importance of play therapy is to allow children move from being unaware of their hidden, unconscious feelings they may have as a result of life experiences, and gain an understanding of their emotions and experiences enabling them to come to terms with feelings. O’Connor and Schaefer (1994) maintain “the aim of play therapy is to bring children to a level of emotional and social functioning or level with their developmental stage. This can allow usual developmental process to be resumed.
Play Therapy is an active process between both the play therapist and the child. It allows the child to explore their surroundings at his or her own pace. The child has his or her own schema of their issues which may be current and of conscious awareness or, hidden in the past and possibly buried in the unconscious. These issues whether of conscious awareness or not may affect the child’s daily lifestyle influencing feelings and behaviour. Play therapy is child centred and the play therapist focuses on play as the first and paramount medium of therapy, with speech the second medium of therapy (British Association of Play Therapists, 2008).
The Irish Play Therapy Association (2013) claim, Play Therapy is an effective method of therapy for children who display or encounter many difficulties or issues. Behavioural difficulties may include depression, aggression, anxiety and other issues relating to difficult encounters or life experiences of abuse, death of a family member, divorce or separation and trauma (www.ipta.ie, 2013).
A history of Play Therapy
Play Therapy dates back as far as 1909 in Europe with the work of Sigmund Freud (1909/1955) and the first documented psychoanalytic therapeutic work focusing on a child was the case of “Little Hans”. Freud discovered the child’s phobias through observations of his play behaviours and dreams. This case encouraged further development of Freud’s work and eventually the development of play therapy.
While Freud used interpretation of the unconscious motivation of a child building a relationship with the child, but he came to the understanding that unlike adults, children do not decide to enter into psychoanalysis. Without consent or understanding the therapist brings the child into this analysis. Anna Freud (1946) followed her father’s interest of play, but developed her own theories. She held that adults undergoing psychoanalysis are required to provide the therapist with information to assist the session, however with children the background information is expressed usually, but not always by the parent.
Melanie Klein (1955) believed the use of psychoanalysis could benefit children in a variety of ways, even if their development was atypical. Klein also believed in using observations with children during their play and behavioural actions and not through their expression of speech as is used within adult psychoanalysis. Klein therefore introduced toys into her sessions to promote play and allow observation of actions to occur.
Virginia Axline working in America was influenced by Carl Rogers work on non- directive client centred psychotherapy. Therefore, Axline built on Roger’s theory resulting in a new therapeutic approach for working alongside children, known as non – directive play therapy. As in adult psychotherapy, the relationship between the therapist and the child in play therapy is based on being genuine, on acceptance and trust.
The theory is that if children are given the opportunity to freely express their feelings and emotions they will resolve these issues themselves, using play experiences and the assistance of their play therapist in order to achieve this (Wilson & Ryan, 2005). Axline (1950) stated that non- directive play therapy is “a play experience that is therapeutic because it provides a secure relationship between the child and the adult, so that the child has the freedom and room to state himself in his own terms, exactly as he is at that moment in this own way and in his own time” (p. 68).
Axline based her theory on her work with a young boy called Dibs. Axline held that Dibs healed himself through no direction over a period of time. She said “No-one ever knows as much about a human being’s inner world as the individual himself. Responsible freedom grows and develops from inside the person”. (Wilson & Ryan, 2005).
Axline, unlike Freud and Klein who both focused primarily on psychoanalysis, believed children would do their best to meet their full potential and by providing a therapeutic relationship and approach which would support that development. Many therapists today base their work on Axline’s (1947) eight principle guidelines
Axline’s principles outline,
The importance of developing a relationship between the therapist and client from the beginning.
Accepting the child and who they are without judgement.
Provide the child with a safe environment to express their feelings completely.
The therapist is alert and available to provide the child with feedback to assist the client’s behaviour,
The therapists provides the child with a scaffold to learn how to cope and solve their own problems and to respect their choices.
The therapist is required not to direct the child in any manner, unless where the child’s safety is at risk. The therapist allows the child to lead the session and the therapist follows their lead.
The therapist is patient and understands it is a gradual process requiring time.
The therapist provides limits that are essential to assist the therapy into a sense of reality and provide the client with information in relation to their responsibilities within the relationship (Axline, 1947).
Based on Axline’s theory of non-directive play therapy, Landreth (2002) developed his theory of Child Centred Play Therapy. Landreth (2002) states the relationship between the child and the therapist must be different from other types of relationships the child has experienced. The relationship between the two is to ensure the child feels safe and comfortable to be expressive within their play, allowing natural communication to occur. He believes the true foundation to the relationship within child centred therapy is that of the bond between the therapist and child (Landreth 2002).
Another influential contribution to the area of play therapy is the work of David Levy (1938). Levy’s Release Therapy allows children release their anxieties through controlled play set out by the therapist. Levy provided free play therapy based on Klein’s theory of free play. Toys are introduced into the settings that are related to the event that requires intervention and the child plays freely with the chosen toys.
Growth of Play Therapy
Child psychotherapy has established a strong tradition across Europe and has grown significantly. In Ireland, child psychotherapy has grown more slowly in comparison to American and Europe. However, professionals’ interest in play as a therapeutic intervention has developed gradually over the past decade. Practioners are becoming more increasingly aware of the seriousness of emotional issues experienced by children and the difficulties that may arise. These children are likely to require more serious treatment that may not be available to them.
Play Therapy Theories and Approaches
There are two techniques used within Play Therapy, non- directive Play Therapy and Directive Play Therapy. Non – directive play therapy approaches are referred to as , “child-focused,” “client – centred” and “unstructured”, where components of directive play therapy are described as “structured,” “directive” and “focused” Gil (1994).
Gil (1994), elaborates on various directive play techniques, including behavioural or gestalt, but suggests that non directive play therapy is a more child focused approach. He explains that non-directive play therapy provides the child the freedom to participate in their own way throughout the session, allowing the therapy to move in specific direction required for the session.
Within structured play therapy, the play therapist plans activities adapting a directive play approach. During the formation of a relationship between the therapist and client within directive Play Therapy a less directive technique is used. This allows the therapist to build a foundation to the relationship and over time, directive techniques are weaned into the relationship (Jones, Casado and Robinson, 2003).
Similarly, supporting this concept, Berting (2009) suggests that building on the concept on developing a therapeutic relationship using a less directive approach is best practice, before proceeding with more directive activities in the core area of the play therapy session. He also suggests observing the child’s need to be able to or prepared to carry out directive play therapy.
Non-Directive Play Therapy ( who are the key people in NDPT and explain what you will discuss
With over 60 years of influential work, Axline’s contribution to non – directive play therapy was outstanding. He is known as the founder of non – directive play therapy and his work still influences play therapists in many ways. He believed the play therapist should have very little influence on the clients play and the client should communicate through their play, which is still a core principle today.
The idea of reaching your full potential as a child in play therapy was originally proposed by Axline (1947). He explained the theory of progressing towards full potential occurs because of the formation of the therapeutic relationship, and not that of specialised techniques.
Ray, Blanco, Sullivan, and Holliman (2009) support Axline’s theory by stating the play therapists develops a relationship with the client by building on their acceptance.. In return, the client develops self-acceptance which results in moving towards their full potential.
Today, play therapists continue to build on the foundations of non-directive approach guided by Axline’s creative work, the area of non-directive play therapy continues to progress, more than 60 years later.
Client-centred play therapy.
Developing the ideas of Axline (1947) and Moustakas (1959), Landreth (2002) improved their theories to develop client – centred play therapy. “In Play Therapy Virginia Axline (1947/69) suggests that the individual has within himself the ability to solve his own problems, and that in play therapy, where conditions for growth are optimal, the child reaches for independence” (Axline, 1955). She expressed the importance of the therapist to allow the child to explore and investigate the room and toys with his own initiative with support of the experience and the relationship (Axline, 1955).
Star this section from Moustakas
Moustakas (1959) felt children required the need to feel they were understood gain self – directed skills in order to grow. These skills could be achieved through client – centred play therapy, focusing on the client’s direction throughout the session.
Astramovich (1999) supported the client – centred therapy approach stating it focuses on the growth and development of the child, and this can be achieved by the child directing their own play through the session.
Directive Play Therapy
Explain to the reader what approaches you will cover:
McMahon (1992) states directive play therapy aims to prepare children for an event that is about to occur, for example surgery or other unpleasant events. Directive play therapy works towards treating the child’s anxieties they may be unaware of. McMahon (1992) suggests the directive approach is closer to psychotherapy than to Axline’s non – directive theory. She elaborates on the therapist having the skills to deal with unexpected circumstances which may arise, and always be prepared and accept the child’s response.
Oaklander (1978) holds that there are the benefits of fantasy and projective methods to use in directive play therapy. He suggests asking children to draw their family as symbols or animals, directing their play to observe their emotional needs. The use of Gestalt methods is expanding over time, the theory behind this approach is beneficial to the child to deal with their feelings they are experiencing at the present, instead to going too far back towards traumatic experiences (McMahon, 1992).
Cognitive Behavioural play therapy
“Cognitive behavioural therapy (CBT) is a form of psychotherapy originally developed for adults, and aims to identify and modify negative thinking styles that cause negative emotions and the maladaptive behaviours associated with those thinking styles” (Knell & Dasari, 2009).
Cognitive behavioural play therapy is a sensitive approach seen to be effective when working with children based on CBT from 8 years and above with various disorders. Cognitive behavioural play therapy is used to teach children strategies to change their negative thinking and views in order to develop positive thinking and understandings (Knell & Dasari 2009).
Green (2008) elaborates on the various styles of the cognitive behavioural approach used within play therapy including, changing their cognitive development, discussing and eliminating senseless beliefs or ideas and cognitive misrepresentations. The play therapist modifies the cognitive behavioural therapy to suit the needs of the child within play therapy.
Gestalt play therapy
Gestalt play therapy, according to Oaklander (2001), focuses on the holistic views of the child, including their body, their emotional state, and their mind. Gestalt Play therapy focuses on the child’s ability to understand how to express their emotions and is essential for a healthy understanding of their own emotions. Oaklander (2001) supports his theory by developing a variety of ways to express ones emotions. Oaklander (2001) suggests clay, art, crafts and puppets to help assist the expression of emotions through play in a directive manner. “The Gestalt work focuses on the “what” and “how” rather than the “why” as found (Oaklander 2001) found.
Alderian Play Therapy
Within Adlerian Therapy, the therapist focuses on and examines the lifestyle of the client and tries to form a relationship of respect and trust with the client in order to set and reach their goals. Adlerian play therapy is a little different as it sets out to appeal to the child but is focused on the Adlerian method just in a child friendly manner. (Morrison 2009).
Kottman (2001) suggests Adlerian play therapy may use techniques from non- directive and focused play therapy in order to the help the child build confidence, courage and abilities by using the Adlerian play therapy method.
It is believed within the Adlerian method behaviours carried out by the client are intentional and by using the Adlerian method of play therapy, children can learn to develop coping mechanisms and strategies as suggested by Kottman and Warlick (1989).
Psychoanalytic play therapy
Melanie Klein, Anna Freud, studied under the Freudian psychoanalysis each developing their beliefs. Both individuals had a major influence of the development of psychoanalytical play therapy
Melanie Klien believed all play was symbolic; in contrast to this Anna Freud believed it was the replay of real life events. Anna believed play therapy was allowing children to talk about the conscious feelings and thoughts and to act out the unconscious; however Klien in contrast to Anna Freud made interpretations from the unconscious meanings to from their play and felt strongly this was the correct understanding (McMahon 1992).
Freud argues for the importance of building a relationship between the therapist and the client in order to provide adequate therapy to the client. She did not believe in interpreting the clients play until the relationship was developed amongst both parties (Cattanach, 1992). Klien argues against Freud, emphasising the importance to begin interpretation without the foundations of a relationship with the child resulting in delays to the therapy (Cattanach, 1992).
Parental / Primary Carer Involvement
The input and involvement of the primary carer is significant when providing Play Therapy to Children. Involvement provides positive outcomes to both the therapist and the child. The therapist can receive back ground information of the problem, the events and behaviours, the primary carer can provide the therapist with information in relation to the child’s progress. Primary carer involvement provides security, stability and emotional support for the child if the therapy may become distressing for the child. A parent’s emotional availability is suggested to be the tool to success of Play Therapy (Wilson & Ryan, 2005)
Primary carer’s may be unaware of what Play Therapy is, and how it is used. As the primary carer brings the child to the centre weekly it is suggested that the therapist should provide adequate information and assistance in relation to the treatment and their part in the therapy (Wilson and Ryan 2005).
The therapist should ensure they don’t replace the parent – child relationship although their relationship is significant for successful results and progress. Play Therapists can involve parents in a variety of ways, for instance the therapist can ask for the parent to sit in on the therapy to assist the settling period, therapist provide feedback to the parents, after each session or after a particular period of time. This can allow therapists provide parents with advice and ideas of how to bring the therapy into the home and provide consistency (Landreth, 2001 and McGuire & McGuire, 2001).
There are independent organisations that within their own country have their own play therapy training; however they adopt the standards of Play Therapy International’s standards. Their training is recognised and certified. Play Therapy Ireland, Play Therapy United Kingdom and Play Therapy Canada are well developed and link with Play Therapy Ireland through their practice. Other countries are gradually developing their own Play Therapy International standards.
The Children’s Therapy Centre are the only APT approved provider in Ireland. Their courses are recognised by the Irish Association for Play Therapy and have approved quality assurance standards with both FETAC and HETAC.
In this chapter a review of the current literature relating to play therapy was addressed. ……… I will present a small scale study carried out on the perception of Play Therapists. In the next chapter I will outline and discuss methods for gathering data for this study. A