Specificity of Children Play Therapy - Research Paper Example

?CHILD-CENTERED PLAY THERAPY INTRODUCTION The current paper presents a comprehensive account of the Child Centered Play Therapy (CCPT). Definition Association of Play Therapy (2008) defines play therapy as "the systematic use of a theoretical model to establish an interpersonal process wherein trained play therapists use the therapeutic powers of play to help clients prevent or resolve psychosocial difficulties and achieve optimal growth and development" (Nash & Schaefer, 2011) Description Play therapy, both directive and non-directive; aim to help children deal with and overcome the difficulties they encounter in their daily lives. It provides a means of expression to the child; just as an adult expresses himself verbally. During directive or structured play therapy the play activities and settings are selected by the therapist while in non-directive or child-centered play therapy (CCPT), the children themselves select them. USE Child centered play therapy is a technique applicable for children in the age range of 3 to 16 yrs, though the age limit can be extended in either direction by play therapists. The therapeutic procedure is highly dependent on the age of the subject and the techniques need to be modified according to the developmental stage of the subject (McMahon, 2009). The therapy can be utilized for a range of mental health problems including physical, emotional, domestic and/or sexual abuse; physical or emotional neglect; experiences of single or multiple trauma, bereavement or loss; illnesses (both physical as well as mental); for children of parents with mental, physical or learning difficulties or similar illnesses. Play therapy has been utilized for certain specific mental health problems namely, Oppositional Defiant Disorder (ODD), Conduct Disorder, Attention Deficit Hyperactivity Disorder (ADHD), Asperger’s Syndrome, Reactive Attachment Disorder, Eating Disorders. Certain behavioral traits not yet diagnosed that can be treated using CCPT include physical aggressiveness, bullying involvement (both target and perpetrator), withdrawn, timid, anxious or scared, selective muteness, self destructive, or suicidal, refusal to attend school or truancy, sexualized behaviors and other antisocial or criminal tendencies (Rye, 2011). HISTORY OF DEVELOPMENT OF PLAY THERAPY The significance of play activities for mental and physical development of children has always been known to mankind. In 1909, Sigmund Freud published a case of a 5 yr old boy suffering with a phobia, the treatment of which involved play therapy. Freud stated that the play activities provide the child with an opportunity for self-expression, wish fulfillment and ability to exercise control over traumatic events. The idea was carried forward and theoretically developed by psychoanalysts Melanie Klein, Margaret Lowenfeld and Anna Freud (Nash & Schaefer, 2011; bapt, 2011). Child Centered Therapy based on a relationship of trust and acceptance between the therapist and the patient was initiated by Carl Rogers (1951, 1955). On the basis of this person centered approach, Virginia Axline (1969) devised a non-directive play therapy. Ever since CCPT has been used in USA by child psychoanalysts In Britain, the same was initiated in 1992 and has played a significant role through British Association of Play Therapy (BAPT) (bapt, 2011). MECHANISM The mechanism of play therapy is based on the inner dynamics of the child irrespective of age, physique or developmental stage. They are the three theoretical principles of actualization, human need for positive regard, and play as a means of communication. The concept of actualization is based on the inherent formative tendency of humans. An individual always strives to achieve his full potentials through pursuits of curiosities, creative activities driven by a desire to acquire independence. Thus a child is considered an individual no different than an adult; who undergoes a developmental process, gathering experiences from a continuously changing world of which he is the centre (Sweeny & Landreth, 2011). The experiences gathered by the child or his phenomenal field, whether conscious or unconscious; internal or external; form and alter his perceptions and become the internal reference point for his developing belief about life. Thus his perceptions and not the actual events are of primary significance in the determination of his behavior and beliefs. Finally is the child’s self or how a child develops as a consequence of his interactions with others around him. This involves the evaluations of the child; the perceptions of others and their reactions towards child’s activities and behaviors. An individual also needs acceptance and regard from his peer, society and family. This need is more pronounced in children. Play is child’s creative medium for self expression and communication (bapt, 2011). Thus the CCPT involves a strategy of self exploration and self discovery based on the Roger’s three fundamental constructs of personality comprising of the person, the phenomenal field and the self. The critical determinant of the success of this strategy is the relationship between the therapists and the child. The therapeutic relationship that forms the core of CCPT involves a stress on child rather than problem and understanding and accepting; rather than explaining and correcting (Sweeny & Landreth, 2011). PROCEDURE The procedure followed for CCPT may vary depending on the issues that are to be dealt with and the setting. However the primary consideration is the establishment of conditions that ensure a child of genuineness, unconditional positive regards and empathy on the part of the therapist. Words can convey this to the child, but the child can be convinced of this only through repeated experiences. The child can be taken to the playroom with selected toys and materials. The therapists should thereafter depend on his verbal as well as non-verbal communication skills to track and understand the child’s behavior and help in process of facilitating creativity, building relationship, developing self esteem, and encouraging communication (Bratton et al., 2007). Axline has provided eight basic principles that should be the guidelines for the role of therapist during the procedure of CCPT (Bratton et al., 2007): 1. Development of warm and friendly relationship with the child 2. Unconditional acceptance 3. Permissiveness to ensure the child is able to express himself freely 4. Understand and reflect child’s feelings 5. Respect the child’s ability to solve his problems and allow him to take charge of the situation 6. Allow child to lead and take not to guide his behavior or activities 7. Attempt to understand the gradual process of child’s activities and not rush in to counseling 8. Establish limitations to enable the child to remain connected with reality; however the limitations must remain minimal. Landreth (2002) suggests the principle of ACT in setting limits: A: Acknowledge the feeling C: Communicate the limit T: Target an alternative REVIEW OF LITERATURE To provide evidences for the efficacy of CCPT, this section presents a recent study conducted by Cochrane and colleagues (2010). Cochrane and colleagues studied two cases of children, Anton and Berto, both six years of age, referred by their teachers. They exhibited attention deficits and aggressive behavior that persisted and intensified from first year in school to next. The two were Hispanic and similar with respect to age, behavioral problem type and severity. The treatment recommended for them was CCPT provided to them during a biweekly 30min. session within the school. While Anton had a waiting period prior to treatment of length equal to treatment period, Berto did not. Data was collected using teacher rating form (TRF) that included 118 items with three grading completed by the boys’ teachers. The clinical behavior in TRF were reported in terms of total score, internalizing and externalizing composites, and eight syndrome scales such as anxiety/depression, withdrawn/depression etc. After the treatment, problem description was done by the individual therapists with each of them answering questions that described their understanding of the boys, their behavior, whether CCPT was of help to them. Next Cochrane, the lead author used TRF in relation with the same questions to understand and arrive at a uniform opinion with the therapists on the basis of TRF grading, therapist observations and discussions. The TRF scores of Anton remained the same over the pre-waiting and post waiting period (total score 107 and 109 respectively), but improved significantly after the treatment (83). During the therapy sessions it was found by the therapists that his home life was chaotic with his mother being at risk of domestic violence. High levels of vigilance due to stress and worry may have accounted for his inattentiveness and aggression. The therapy session focused on self expression and independent choice making for Anton that led to the improvement. A mentoring program involving parent teacher and teacher was next recommended for him. Berto was referred for aggression and inattentiveness like Anton, but his pre-treatment ratings suggested anxiety and depression to be his major problems. He was over-conscious, overtly hurt by criticism, unable to concentrate, impulsive and attention seeking. His total scores as well as the internal and external composite scores, and syndrome scores were in clinical range. Therapist recognized his problem to be a low sense of self worth resulting from frequent and harsh punishments at home. Berto’s TRF improved as a consequence of CCPT (107 to 70). His attention scores too came in the normal range of 30 from earlier clinical range of 40. He was able to establish a warm and friendly relationship with the therapists and was no more under the stress of being the centre of attention during class. Attention span and aggressive behavior too improved. CCPT was a reformative behavior for Berto that provided him with the care and attention that he starved for. It further changed his self-perception which instilled the unconditional positive self regard in him. CONCLUSION Studies have provided evidences for the immense potential of CCPT in dealing with disruptive classroom behavior irrespective of the nature and cause of the behavior. CCPT is effective for a range of mental and behavioral problems including anxiety and depression post trauma. Mental problems of clinical nature along with such issues as ADHD, ODD and autism have been reported to be dealt with using this technique. Further the CCPT plays a significant role in understanding the underlying troubles leading to the development of behavioral problems (Cochrane et al., 2010; Cochrane and Cochrane, 2006; Landreth, 2002). CCPT is recommended for two basic reasons; it uses play; a natural activity intimately associated with childhood as a means of communication and enhancing self-expression, self-awareness and decision making ability. Further since the therapy brings about changes in the personality of the individual, these changes are easy to carry forward and more probability to become permanent. Play therapy is a tool in the hands of teachers which if used properly can help them deal with difficult behaviors with patient and empathy. REFERENCES 1. bapt. (2011, October). A history of play therapy. Retrieved November 2011, from british association of play therapy: http://www.bapt.info/historyofpt.htm 2. Bratton, S. C., Ray, D., & Landreth, G. (2007). Play therapy. In M. Hersen, & A. M. Gross, Handbook of clinical psychology (p. Ch 20). NJ: John Wiley & Sons. 3. Cochrane, J. L., & Cochrane, N. H. (2006). The heart of counselling: a guide to developing therapeutic relationships. CA: Thomson Brooks/Cole. 4. Cochrane, J. L., Cochrane, N. H., Nordling, W. J., McAdam, A., & Miller, D. T. (2010). Two case studies of child centered play therapy for children referred with highly disruptive behavior. International journal of play therapy , 130-143. 5. Landreth, G. (2002). Play Therapy: the art of relationship. NY: Brunner-Routledge. 6. McMahon, L. (2009). The handbook of play therapy and therapeutic play. 2nd ed. Hove (UK)/New York: Routledge. 7. Nash, B., & Schaefer, C. E. (2011). Play Therapy. In C. E. Schaefer, Foundations of play therapy (Ch1). NJ: John Wiley & Sons. 8. Rye, N. (2011). Child-Centred Play Therapy. Retrieved November 12, 2011, from International Encyclopedia of Rehabilitation: http://cirrie.buffalo.edu/encyclopedia/en/article/275/ 9. Sweeny, D. S. (2011). Child centered play therapy. In C. E. Schaefer, Foundations of play therapy (Ch 8). NJ: John Wiley & Sons. Read More