Play Therapy as a Therapeutic Intervention - Report Example

Efficacy of Play Therapy (INSERT YOUR NAME HERE) (INSERT NAME OF YOUR UNIVERSITY HERE) Efficacy of Play Therapy Play therapy is now a well-established and commonly used method in clinical practice for treatment of children with different complications. Clinicians agree that there are several reasons why play can be the best therapy for children (Ginsberg, 2007). For instance, children do not have concrete verbal skills that can effectively enable them go about their problems, thoughts, feelings and behaviours. Besides, they have not developed abstract reasoning that can necessitate the articulation of some of the challenges they face in life. For their problems to be taken care of, they best converse through toys and running throughout the day. According to Greenspan and Wieder (1997a), play therapy is a multifaceted field of study and its understanding has to encompass factors within the environment. They therefore consider such and define play therapy as interpersonal affair whereby a qualified therapist systematically deals with the patient or the victim through application of curative powers of play. They add that such process should be able to help the client resolve psychological problems faced with as well as impart in them the necessary skills to deal with future difficulties. Just et al. (2006) agree with Greenspan and Wieder but add that such process should succinctly specify how to use the play materials available to the victim so that the therapeutic powers of the play can effectively be implemented. Looking at the aspect from psychoanalytic point of view, Just et al. (2006) believe that Greenspan and Wieder has gone wrong by failing to include the aspect of psychoanalytic interventions when defining play therapy. They therefore define the process as modification of available psychoanalytic techniques such as free association so that specific needs of the child can be met. The purpose of this essay is to evaluate the efficacy of play therapy on children. As the definitions above have it, play therapy can be seen as one of the therapeutic approach that can work well with children having different complications. Therefore, the essay will describe and criticise the approach along with its theoretical underpinnings. Play Therapy Interventions Method There have been set of theoretical elements that help in understanding interventions method for play therapy. For instance, some therapists choose to work from their best suited theoretical basis such as Psychoanalytic or Gestalt. Each of the available theoretical frameworks explains therapeutic interventions that can be used for better results. These interventions include but not limited to: Child-Centered Play Therapy This is an intervention that has proved that play therapy provides a child with natural means for self evaluation and communication besides providing means for communication through variety of emotions. Rogers (2000) defines the method as a situation where the child has the responsibility directing and leading the therapy session. In so doing, the child is allowed to express their attributes or feelings. Just like the counselor would do with adult client, s/he will be expected to understand the internal world of the child through his/her own selected materials. This intervention method is grounded on the fact that the child has some natural tendency towards growth and actualisation (Lord and McGee, 2001). Landreth (2002) terms this intervention as non-directive thus the child should be given the opportunity to lead and direct the session. The counselor will only be allowed to analyse child’s affect and provide the necessary materials that can be chosen. Some of the materials that can be availed include culturally diverse doll families, nursing bottles, toy animals, puppets, doll house and other art materials. a. Roles of Adults in Child-Centered Play Therapy (None-directive) Roles of adults in child centered therapy depend on the specific needs of the child. For instance, filial therapy requires that adults be trained by councilors so as to be able provide counseling session during times that the counselor may be away from the child. Adults also have a role in ensuring that they attend some sessions either at the beginning or the middle of the therapy. This will equip them with necessary highlights and information regarding the process of therapy. In so doing, there will be existence of collaborative work between the counselor, the adult and the child. Adults have the role of ensuring that counselors are provided with the necessary information that will help in the therapist give the correct accommodation especially if the case involves a child with special need. Focused Play Therapy This is another intervention method that needs to be applied while dealing with a more directive problem. This method operates on the premise that there can be collaborative selection of play materials by councilor and the child so that self efficacy can best be attained (Siller and Sigman, 2002). Focused approaches can be utilised to teach alternative behaviors and varied skills unlike child-centered which gives the child free exploration. Siller and Sigman explain that while the relationship between the councilor and the child should remain essential, counseling approaches used in this case may incorporate essential theories that are known to be associated with traditional child-centered approach. Basing the assumption from the presumed basis for behavioral and emotional complexities, it will not be harmful for councilors to utilise either relationship play therapy techniques, Adlerian, Gestalt or Jungian (Andronico et al. 1967). To understand the effects of play therapy on child whose parents have separated, Andronico et al. further argue that focused therapy can be essential especially if utilised as a time-limited intervention. Prescribed Play Therapy As explained above, it is easy to generalise that child-centered play therapy and focused play therapy techniques can be adaptable to cater for developmental and emotional needs of a child. When a counselor decides to use either child-centered play therapy or focused play therapy then such is described as prescribed play therapy (Guerney, 1976). Integration of these methods will also depend on the specific needs of the child. Guerney advices that counselors using prescribed play therapy should be well acquainted with different approaches to play and use his/her best skills while applying these strategies. Prescribed play therapy gives counselors ability to indentify both long and short term needs of the victim and have an understanding of the world around the child through her or his play. He adds that the flexibility of this intervention method gives counselors advantage of addressing the specific needs of children with special disabilities as well as promoting their positive outcomes. Benefits of Play Therapy to Children Play therapy has been widely used both domestically and at clinical levels to treat children’s behavioral, emotional and socio-economic difficulties. This has been attributed to the ability of the therapy to offer unique responsiveness to children’s unique and varied developmental needs. Piaget (1962) realised that most children will respond to plays as the only way of curing their problems since they have not developed the needed abstract thought which has been viewed as a prerequisite to understanding nature, solve complex issues and verbally express themselves. Therefore children benefit through play therapy as it is their concrete source of interaction. To begin with, (Association for Play Therapy (APT), 1991 as cited in Vanfleet, 2000) explains that play therapy has helped children deal with complexities in their lives. Association for Play Therapy applied meta-analytic methodology in its investigation of benefits of play therapy to children. The use of meta-analytic methodology allowed the association to overcome the limitation of sampling small size, typical of therapeutic research. Out of 300 children sampled, the association finds that play is child’s natural mode of expression. At least 74% of the sampled population could be trusted to solve their own problems through their play. It further asserts that since play therapy is child’s natural mode of expression, that is itself psychotherapeutic treatment modality for child’s behavioral, emotional and socio-economic challenges. Building on Association for Play Therapy work, Guerney (2001) agrees that play therapy is a recipe to psychological problems faced by children. He further suggests that child-centered play therapy has been able to help children faced with domestic problems such as divorce and child molestation. This approach however, (child-centered play therapy) has been beneficial when children are allowed to express their attributes or feelings that are seen to be very threatening for traditional modes of counseling. Secondly, Hatch (1990) applied another approach of play therapy known as focused play therapy so as to ascertain its benefits on children. He sampled 89 kidnapped children and taught them new skills and behaviours. His relationship with the children remained essential component to play therapy. He also utilised Adlerian, Gestalt and Jungian techniques to ensure that focused play strategy benefits the sampled group. The study reports that children who were cooperative and participated in the designed play managed to overcome the trauma. In a similar case, Greenspan (1992) had a study on benefits of play therapy on 28 children who had been kidnapped in a school bus. After escaping, the author gave them ongoing play therapy. Some refused to be part of this therapy. The group that agreed was compared to other children who were not part of the tragedy, and with group of adults who once experienced trauma in childhood. It was realised that the group comprising adults did not benefit much since they have developed abstract reasoning to solve their problems thus play therapy do not contribute much. Children who were not part of the trauma only benefited on therapies that were specific to their other needs. However, the other 23 children who accepted the therapy had much of their social, behavioral and psychological complications solved compared to the other 5 who opted out of the therapy. Simpson (2005) recounts his psychotherapeutic work with his sexually abused boy. The intensive therapeutic play went on for 3 months. He concludes that the boy developed an awareness of some affective states, able to relate such states to the environment around him and even skills to verbally express his feeling in an appropriate manner. Finally, Solomon et al. (2007) admit that play therapy is a beneficial process to children since they will be able to conceptualise structure the environment around them. Play also furnishes children with ability to solve situations which have been disturbing, confusing and conflicting. Solomon et al. further explain that play should not be regarded as children’s play. Instead, adults should help children through plays especially those who tend to lack semantic fluency. In so doing, growth of perceptive process will be enhanced. The Efficacy of Play and Filial Therapy to Development of Children The efficacy of psychological interventions for the development of children has been a controversial area of study among mental health professionals. While play therapy has been defined earlier in this essay, filial therapy on the other hand is a therapeutic intervention technique that has been designed to assist parents and other paraprofessionals with basic child-centered play therapy principles (Ginsberg et al., 1978). Play and filial therapies are modalities uniquely suited for children that can help them resolve or prevent psychosocial problems and attain optimal development. According to Ginsberg et al. (1978) play and filial therapies have been recommended by clinicians because they observe that children do not have cognitive strength to concretely express their thoughts and feelings. Therefore integration of both therapies has been essential since they offer children emotionally safe and age-appropriate means of expressing their feelings. Research done by Andronico (1983) on 50 9-13 years old children attest to this assertion. The author finds that after receiving fusion of play and filial therapies, children showed significant improvement in intellectual and social flexibility. This was further compounded by decreased anxiety and behavior disorders compared to unattended group. On the other hand, research conducted by Guerney, (1983) shows results that strongly points to greater utilisation of filial therapy over play therapy. He participated in training parents and involving them to conduct play therapies to their children. He realises that this method was highly effective besides having the potential of preventing children from costly effects across the lifespan. Dunn (1999) however, does not agree with these findings arguing that the research conducted lacks some essential psychological elements. For instance, he argues that available research that previously compared filial therapy and play therapy by clinicians or therapies have dealt with same population. This is the element that Guerney lacked thus cannot give good determination if the factors of presenting issue and children’s age influence his deduction. Furthermore, Dunn (1999) had a research on 48 children between the ages of 3 to 6 years to determine the efficacy of play and filial therapies. After 10 sessions of the integrated therapies, bilingual Puerto Rican children depicted improvement as compared to the group set as control test. As measured by Peer Rating Scale, the group that participated in the experiment became resistant to racial discrimination faced. Smith (1999) builds on this research by arguing that before the fusion of both therapies, there need to identify crises in children’s mental health services. Vogelsong et al. (2000) combine filial and play therapy in their research and the resultant effect of such therapies. Comparing the result of their research and others done previously, including individual work with group, children and interventions with families, filial and play therapy enhances genuine response to children distress. Interestingly, Smith (1999) and Dunn (1999) criticise the efficacy of filial and play therapy. They argue that the theoretical models used to research the effectiveness of the two therapies do not conform to clinical requirements. They made this conclusion after completing a meta-analysis of the presented research outcomes of therapeutic interventions involving filial and play done on young people and children. While most of the researches and studies they reviewed pointed importance of play and filial therapy, their final recommendation (a review of the research presented) argues that none of the researches reviewed showed any relationship between child’s improvement and therapy applied. They add that play is so natural in children that we do not have to add anything to make children recover from their anxieties. Introduction of such therapies is just taking advantage of a process that is already happening naturally. They thus conclude: “What these studies lack thus far is convincing evidence that the large positives of both play and filial therapies are psycho driven. Demonstrated in the reviewed psychotherapy researches thereof, is just a replication of clinic and a community setting where what is happening is so natural without any interventions.” (Dunn, 1999 pg. 324) a. Efficacy of Play Therapy on Children with Disorders Though it has been a misconception, parents tend to imagine that play therapy is best suited to children with disabilities. Every child benefits from a well structured play therapy but contemporary scholars have started studying the efficacy of play therapy on children with special needs. Kaduson and Schaefer (1997) explain that feeling word game as technique of play therapy has been confirmed to help children with attention-deficit/ hyperactivity disorder (ADHD) cope well with challenges affecting their lives. Successful case regards the research which was conducted by Kaduson and Finnerty (1997) on some 63 children aged between 8 and 12. Kaduson and Finnerty realised that when they compare 3 groups of children with ADHD and another as a control group, the three groups diagnosed with ADHD showed significant drop in hyperactivity symptoms as their parents reported. However, the therapy failed to generate significant effect on the control group. To concretise this evidence, Kaniuga (1990) also did similar test on 60 children aged between 7 and 11. The author discovered that group of children who participated in 4 sessions over 4 days engaging in games such as the Clubhouse showed significant short term improvement in their internal locus of control orientation. There have also been researches on the efficacy of play therapy on children who are mentally challenged. For instance, George, Braun and Walker (1982) did a comprehensive study on 60 children between the ages of 3 and 8. They realised that those who had development delays and participated in group and individual developmental therapy as well as play therapy for individuals who had minimal score on self-concept managed to score highly in the test that required responses on developmental tasks compared with the control group when measured using Cooperative Preschool Inventory. Most recent research has also examined children with withdrawal behaviours. A good example is the research done by Guerney (2001). He examined 45 boys to find the implication of play therapy on their socially withdrawn and maladjusted behaviours. He compared these boys in four groups. Verbal group received verbal reinforcements by therapist for social-approach behavior; play group on the other hand received tangible reinforcement when social-approach behavior occurred. He placed control group A as one in play room with no therapist while control group B in individual play rooms by themselves for 10 sessions in all groups. The research revealed that the token group more of behavior changes compared with the verbal group. Interestingly, verbal group changed more than the control group A. Control group B changed more than A. When measured on California Test of Personality and Devereux Child Behavior Rating Scale, group B showed no significant behavior change. This test conforms to the recently test carried to investigate the effect of play on emotionally maladjusted children. The research investigated 68 children with emotional maladjustment. The author realised that emotionally maladjusted children who received 7 individual child-centered play therapy sessions and 4 group play therapy showed significant improvement on the ability to read and interpret graphs independently. After 30 days of follow up, the improvement of on an improving trend. More interesting is the research on children with autism. The first research involved a researcher investigating 20 children between ages of 4 and 11. The research found that boys diagnosed with chronic autism who participated in a 60 session of operant conditioning then 40 sessions of sand play therapy (Group A) over 3 months or participated in 40 sessions of operant conditioning then followed with 60 sessions of play (Group B) showed significant total improvement in their mental age as measured by Woodlands Mental Development and Griffiths Mental Development scales. Andronico et al. (1967) explains that operant conditioning was introduced in this case as it is more effective due to a non-significant increase for the group A and significant improvement in group B. Play Therapy Motivation, Techniques and Legislations Effective techniques for play therapy are closely related to factors that motivate the therapy. In the event that these techniques are mentioned, motivation factors will be the basis for such. Rogers (2000) discusses about 15 clinically proven play therapy techniques which have been helpful in reducing children’s social problems. Some of the common techniques also highlighted by other authors include: a. The Feeling Word Game This is a technique believed to be assisting children to verbalise their feelings. The rationale for this therapeutic technique is that when incorporated in the play, children will be able to freely talk about their feelings. Kaduson and Schaefer (1997) explain that such free expressions are brought about by child’s reduced defenses. Kaduson and Schaefer also did a study using feeling word game and concludes, ‘…we are seeing children being allowed to communicate their feelings in an impressive and non-threatening way” (pp. 19–21) they add, “we have opted for it as it can be used by all children including those with conduct problems” (pp.23-24). It can thus be concluded that the motivating factor behind Kaduson and Schaefer choice is the ability of this technique to offer solution to issues that have been too intimidating for the child to be able to express him/herself freely. b. The Pick-Up-Sticks Game This technique was first tried by Barbara McDowell (Kaduson and Schaefer, 1997, pp. 145–149). The motivating factor behind this technique was to bring out affective expression in children. It needs familiarity with colour-feeling pairs for children to have fun with this technique. c. Beat the Clock This play therapy technique was designed by Heidi Kaduson (Kaduson and Schaefer, 1997, pp. 139-141). The motivator was to increase self and impulse control of the child. Rogers (2000) also adds that this technique should be used by counselors intending to help children resist distraction and remain focused on activities that they are undertaking. The fact that the child is rewarded after completing a task imparts a sense of accomplishment and competence in them. d. Weights and Ballons Celia explains that therapists who are looking to make children understand abstract therapeutic constructs simple should opt for Weights and Ballons (Kaduson and Schaefer, 2001, pp. 115-117). It also encompasses techniques children can find enjoyable and ideal making children to get meaning of complex materials. Basically, the technique provides a mechanism of making easy somewhat complex cognitive-behavioral theory of depression. The analysis of play therapy techniques will be incomplete without standards that have been set to regulate practices of therapists. To begin with, researches put Play Therapy International as pioneers of world’s first standards for training and practices (Lord and McGee, 2001). United Kingdom through Play Therapy United Kingdom (PTUK) has also suggested systematic models of play therapy practices to be used. This has further generated some legislation United Kingdom follows when engaging in play therapy. Giving examples; play therapy has to be restricted to statutory specifications or requirements and ethical systems and standards. Legislation is treated differently from one country to another but should be part of the therapy. Practitioners should always have support from national support body. For instance, in England, counselors can be supported by Play Therapy United Kingdom (PTUK). It is also recommended that in countries where there are no specific organizations, international ones such as Play Therapy International (PTI) should act on the same capacity. The figure below shows PTUK’s adopted systemic model of play therapy practice that helps therapist adhere to the required legislation. Figure 1.0: Systemic Model of play Therapy Practice Source: Play Therapy United Kingdom (PTUK) Other legislations working in countries such as Australia requires that the competencies on which the therapy is based should be founded on a realistic play therapy evidence base. References Andronico, M. P. (1983). Filial therapy: A group for parents of children with emotional problems. In Rosenbaum (Ed.), Handbook of Short Term Therapy Groups. New York: McGraw Hill, 3-21. Andronico, M. P., Fidler, 1., Guerney, B. G., Jr., and Guerney, L. (1967). The combination of didactic and dynamic elements in filial therapy. International Journal of Group Psychotherapy, 11, 10- 17. Dunn, W. (1999). The Sensory Profile manual. San Antonio, TX: The Psychological Corporation. Ginsberg, K. R. (2007). The importance of play in promoting healthy child development and maintaining strong parentchild bonds. Pediatrics 119 (1): 182-191. Ginsberg, B. G., Stutman, S. S., and Hummel, J. (1978). Notes for practice: Group filial therapy. Social Work, 23(2), 154-156. Guerney, L. (2001). Child-centered play therapy. International Journal of Play Therapy, 10(2)13-31. Guerney, L. (1983). Client-centered (non-directive) play therapy. In C. Schaefer & K. O'Connor (Eds.), Handbook of Play Therapy. New York: J. Wiley & Sons, 21-64. Guerney, B. G. (1976). Filial therapy used as a treatment method for disturbed children. Evaluation, J, 34-35. Greenspan, S. 1. (1992). Infancy and early childhood: The practice of clinical assessment and intervention with emotional and developmental challenges. Madison, CT: International Universities Press. Greenspan, S. 1., and Wieder, S. (1997a). An integrated developmental approach to interventions for young children with severe difficulties in relating and communicating. Zero to Three: National Center for Infants, Toddlers, and Families 15, no. 5. Hatch, E. J. (1990). Filial Therapy, VHS videotape, 50 minutes. Available from NIRE/IDEALS, 12500 Blake Road, Silver Spring, MD 20904. Information/order: E-mail niremd@nire.org Just, M., V., Cherkassky, T., Keller, R. Kana, and Minshew, N. (2006). Functional and anatomical cortical underconnectivity in autism: Evidence from an MRI study of an executive function task and corpus callosum morphometry. Cerebral Cortex. 16, no. 7. Kaduson, H., and Schaefer, C. (Eds.). (1997). 101 favorite play therapy techniques. Northvale, NJ: Jason Aronson. Landreth, G. L. (2002). Play therapy: The art of the relationship (2nd ed.). New York: Brunner- Routledge. Lord, c., and J. P. McGee, eds. (2001). Educating young children with autism. Washington, DC: National Academy Press. Piaget, J. (1962). Play, dreams and imitation in childhood (C. Gattengo & F. M. Hodgson, Trans.). New York: Norton. Rogers, S. J. (2000). Interventions that facilitate socialization in children with autism. Journal of Autism and Developmental Disorders 30 (5): 399-409. Simpson, R. (2005). Evidence-based practices and students with autism spectrum disorders. Focus on Autism and Other Developmental Disabilities 20 (3): 140-149. Siller, M., Sigman. M. (2002). The behaviors of parents of children with autism predict the subsequent development of their children's communication. Journal of Autism and Developmental Disorders 32 (2): 7789. Smith, T. (1999). Outcome of early intervention for children with autism. Clinical Psychology: Science and Practice 6:33-49. Solomon, R, J. Necheles, C. Ferch, and D. Bruckman. (2007). Pilot study of a parent-training program for young children with autism: The PLAY Project Home Consultation Program. Autism 11 (3): 205-224. Vanfleet, R. (2000). Short-term play therapy for families with chronic illness. In H. G. Kaduson & C. E. Schaefer (Eds.), Short-Term Play Therapy for Children, New York: Guilford Publications., Inc., 175-193. Vogelsong, E., Guerney, B. G., and Guerney, L. (2000). Filial Therapy, VHS videotape, 40 minutes. Available from NIRE/IDEALS, 12500 Blake Road, Silver Spring, MD 20904. Information/order: E-mail niremd@nire.org Read More

Play Therapy Interventions Method There have been set of theoretical elements that help in understanding interventions method for play therapy. For instance, some therapists choose to work from their best suited theoretical basis such as Psychoanalytic or Gestalt. Each of the available theoretical frameworks explains therapeutic interventions that can be used for better results. These interventions include but not limited to: Child-Centered Play Therapy This is an intervention that has proved that play therapy provides a child with natural means for self evaluation and communication besides providing means for communication through variety of emotions.

Rogers (2000) defines the method as a situation where the child has the responsibility directing and leading the therapy session. In so doing, the child is allowed to express their attributes or feelings. Just like the counselor would do with adult client, s/he will be expected to understand the internal world of the child through his/her own selected materials. This intervention method is grounded on the fact that the child has some natural tendency towards growth and actualisation (Lord and McGee, 2001).

Landreth (2002) terms this intervention as non-directive thus the child should be given the opportunity to lead and direct the session. The counselor will only be allowed to analyse child’s affect and provide the necessary materials that can be chosen. Some of the materials that can be availed include culturally diverse doll families, nursing bottles, toy animals, puppets, doll house and other art materials. a. Roles of Adults in Child-Centered Play Therapy (None-directive) Roles of adults in child centered therapy depend on the specific needs of the child.

For instance, filial therapy requires that adults be trained by councilors so as to be able provide counseling session during times that the counselor may be away from the child. Adults also have a role in ensuring that they attend some sessions either at the beginning or the middle of the therapy. This will equip them with necessary highlights and information regarding the process of therapy. In so doing, there will be existence of collaborative work between the counselor, the adult and the child.

Adults have the role of ensuring that counselors are provided with the necessary information that will help in the therapist give the correct accommodation especially if the case involves a child with special need. Focused Play Therapy This is another intervention method that needs to be applied while dealing with a more directive problem. This method operates on the premise that there can be collaborative selection of play materials by councilor and the child so that self efficacy can best be attained (Siller and Sigman, 2002).

Focused approaches can be utilised to teach alternative behaviors and varied skills unlike child-centered which gives the child free exploration. Siller and Sigman explain that while the relationship between the councilor and the child should remain essential, counseling approaches used in this case may incorporate essential theories that are known to be associated with traditional child-centered approach. Basing the assumption from the presumed basis for behavioral and emotional complexities, it will not be harmful for councilors to utilise either relationship play therapy techniques, Adlerian, Gestalt or Jungian (Andronico et al. 1967). To understand the effects of play therapy on child whose parents have separated, Andronico et al.

further argue that focused therapy can be essential especially if utilised as a time-limited intervention. Prescribed Play Therapy As explained above, it is easy to generalise that child-centered play therapy and focused play therapy techniques can be adaptable to cater for developmental and emotional needs of a child. When a counselor decides to use either child-centered play therapy or focused play therapy then such is described as prescribed play therapy (Guerney, 1976).

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