Play therapy

Landreth, Garry

Children are not miniature adults. Just as their world is a world of concrete realities, so, too, their means of communicating their world is done on a child's developmental level through play. Play has long been recognized as having a significant role in the children's lives.

As early as the 18th century, Rousseau wrote about the importance of observing children's play to learn about children and to understand them. Play therapy has evolved over the last century as the treatment of choice for helping children who are experiencing emotional and behavioral difficulties. Unlike adults, whose natural means of expression is verbalization, the natural means of expression for children is play and activity. Developmentally, children do not have the cognitive ability to explicitly express themselves verbally or the ability to fully understand self-aspects and motives behind behavior when communicated on a purely verbal level.

Symbolically through play, children can begin to understand and express their world. In seeking to facilitate children's expression and exploration of their emotional world, therapists must turn loose of their world of reality and abstract verbal expression and must move into the symbolic, conceptual-expressive world of children. Landreth (1991) defined play therapy as

a dynamic interpersonal relationship between a child and a therapist trained in play therapy procedures who provides selected materials and facilitates the development of a safe relationship for the child to fully express and explore self (feelings, thoughts, experiences, and behaviors) through the child's natural medium of communication, play. (p. 14)

RATIONALE FOR PLAY THERAPY

The universal importance of play to the natural development and wholeness of children has been underscored by the United Nations proclamation of play as a universal and inalienable right of childhood. Just as childhood has intrinsic value and is not merely preparation for adulthood, so, too, play has intrinsic value. Frank (1982) suggested that play is the way children learn what no one can teach them.

Functions of Play

Play is the way children learn about the world around them as they attempt to organize and understand their experiences. Play also gives children an opportunity to gain a sense of control and mastery over their world as they explore and experiment with toys and other play media. According to Piaget (1962), play bridges the gap between concrete experience and abstract thought, allowing children to learn to live in our symbolic world of meanings and values. In play, the child is dealing in a sensory-motor way with concrete objects that are symbols for something else the child has experienced directly or indirectly. Sometimes the connection is quite apparent. Other times the connection may be rather remote.

Play in the Therapeutic Process

In play therapy toys are viewed as the child's words and play as the child's language-a language of activity. Play therapy, then, is to children what counseling or psychotherapy is to adults. In play therapy the symbolic function of play is what is so important, providing children with a means of expressing their inner world. Emotionally significant experiences can be expressed more comfortably and safely through the symbolic representation the toys provide.

Given the opportunity, children will play out their feelings and needs in a manner or process of expression that is similar to that for adults. Although the dynamics of expression and the vehicle for communication are different for children, the expressions (fear, satisfaction, anger, happiness, frustration, contentment) are similar to those of adults. Children may have considerable difficulty trying to tell what they feel or how their experiences have affected them. If permitted, however, in the presence of a caring, sensitive, and empathetic adult, they will reveal inner feelings through the toys and materials they choose, what they do with and to the materials, and the stories they act out. Children's play is meaningful and significant to them, for through their play they extend themselves into areas they have difficulty entering verbally.

Because the child's world is a world of action and activity, play therapy provides the therapist with an opportunity to enter the child's world. The child is not restricted to discussing what happened; rather, the child lives out at the moment of play the past experience and associated feelings. If the reason the child was referred to the therapist is aggressive behavior, the medium of play gives the therapist an opportunity to experience the aggression firsthand as the child bangs on the Bobo or attempts to shoot the therapist with a gun and also to help the child learn self-control by responding with appropriate therapeutic limit-setting procedures.

Without the presence of play materials, the therapist could only talk with the child about the aggressive behavior the child exhibited yesterday or last week. In play therapy, whatever the reason for referral, the therapist has the opportunity to experience and actively deal with that problem in the immediacy of the child's experiencing. Axline (1947) viewed this process as one in which the child plays out feelings, bringing them to the surface, getting them out in the open, facing them, and either learning to control them or abandon them.

HISTORICAL DEVELOPMENT FOR PLAY THERAPY

Throughout time and across cultures, play has been recognized as significant in children's lives. Rousseau (1762/ 1930) was one of the first to acknowledge the importance of play in educating children. Not until the early 20th century, though, was the symbolic function of play recognized. Froebel (1903) proposed that play has a definite conscious and unconscious purpose, regardless of the nature of the play, and therefore can be looked to for meaning.

Play is the highest development in childhood, for it alone is the free expression of what is in the child's soul.... Children's play is not mere sport. It is full of meaning and import. (Froebel, 1903, p. 22)

The use of play in a therapeutic setting began in the early 1900s as an attempt to apply psychoanalytic therapy to children. Since that time, five major developments in the emergence of play therapy have produced a viable approach to counseling with children: psychoanalytic play therapy, release play therapy, relationship play therapy, nondirective play therapy, and play therapy in school settings.

Psychoanalytic Play Therapy

Psychotherapy with children and the use of play in therapy originated with the classical child analysis case of Little Hans by Sigmund Freud in 1909. Freud saw Hans only one time for a brief visit and conducted the treatment by advising Hans' father of ways to respond with suggestions based on the father's notes about Hans' play. Following Freud's work with Hans, Hermine Hug-Hellmuth seems to have been one of the first therapists to emphasize play as essential in child analysis and to provide children in therapy with play materials to express themselves.

In 1919 Melanie Klein began to employ the technique of play as a means of analyzing children under age 6. She assumed that child's play is as motivationally determined as adults' free association. She carried out analysis by substituting play for verbalized free association. Thus, play therapy provided direct access to the child's unconscious mind.

During this same period, Anna Freud began to use play as a way to encourage children to form an alliance with her. Unlike Klein, she emphasized the importance of developing the emotional relationship between the child and the therapist before interpreting unconscious motivation behind the child's drawings and play. Both Klein and Freud stressed the importance of uncovering the past and strengthening the ego.

Release Play Therapy

The second major development in formulating play therapy occurred in the 1930s with the work of David Levy in developing release therapy, a structured play therapy approach for children who had experienced a specific traumatic event. A related structured approach, referred to as active play therapy, was developed by J. C. Solomon for impulsive children who were acting out. Both approaches were based on a belief in the abreactive effect of play.

Relationship Play Therapy

The emergence of the work of Otto Rank, Frederick, Allen and Jessie Taft, referred to as relationship therapy, constituted the third significant development in play therapy. In this approach, the therapeutic relationship was hypothesized to have curative powers. Therefore, major emphasis was placed on the dynamics of the therapist-child relationship and realities of the present. The work of the relationship therapists was expanded and studied by Carl Rogers, who extended these earlier concepts and developed nondirective therapy, later referred to as client-centered therapy.

Nondirective Play Therapy

In the late 1940s, Virginia Axline successfully applied nondirective therapy principles (belief in the individual's natural striving for growth and the individual's capacity for self-direction) to children in play therapy. Nondirective play therapy makes no effort to control or change the child and is based on the theory that the child's behavior at all times is a function of the drive toward self-realization.

The objectives of nondirective play therapy are to help the child become self-aware and self-directed. The therapist actively reflects the child's thoughts and feelings, believing that when children express, identify, and accept feelings, they can accept the feelings and then are free to deal with these feelings.

In summarizing her concept of play therapy, Axline (1950) stated,

A play experience 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 his own way and in his own time. (p. 68)

This approach was later termed client-centered play therapy and, most recently, child-centered play therapy. (Landreth, 1991)

Play Therapy in School Settings

When guidance and counseling programs were established in elementary schools in the 1960s, it opened the door to the fifth major development in play therapy. Until the 1960s, literature on play therapy indicated that this treatment was largely the domain of the private practitioner with a focus on treating maladjusted children. With the addition of counselors in elementary schools, however, counselor educators such as Alexander (1964), Landreth (1972), Landreth, Jacquot, and Allen (1969), Muro (1969), Myrick and Holdin (1971), Nelson (1966), and Waterland (1970) were quick to describe their play therapy experiences in the literature. These authors encouraged the use of play therapy in school settings to meet a broad range of the developmental needs of all children, not just those who are maladjusted. This trend toward the preventive role of play therapy has continued.

In their textbook for school counselors, Dimick and Huff (1970) suggested that until children reach a level of facility and sophistication with verbal communication that allows them to express themselves fully and effectively to others, the use of play materials is mandatory if significant communication is to take place between child and counselor. It seems, then, that the question is not whether the elementary school counselor should use play therapy but, instead, how play therapy should be used in elementary schools. Landreth (1991) suggested that school counselors use the term "counseling with toys" instead of play therapy to avoid potential problems with the term "therapy."

The ultimate objective of elementary schools is to assist the intellectual, emotional, physical, and social development of children by providing adequate learning opportunities. Therefore, a major objective of utilizing play therapy with children in an elementary school setting is to help children with their difficulties so they can benefit from the learning experiences offered. Play therapy, then, can be viewed as an adjunct to the learning environment, an experience that assists children in maximizing their opportunities for learning.

THE PLAYROOM AND MATERIALS

Whether a play therapist has access to a fully equipped, dedicated playroom or must utilize a portable playroom set up in a corner of an office, the atmosphere of the playroom is of critical importance. Creating an environment that conveys a clear message, "This is a place for children," requires planning, effort, and sensitive understanding of how it feels to be a child. The look of the toys and materials should say, "Use me." Therefore, a comfortable space with well-worn toys is preferable.

Selecting Play Materials

Because toys and materials are part of the communicative process for children, careful attention must be given to selecting appropriate items. The rule is selection rather than accumulation. Play areas and playrooms containing an assortment of randomly acquired toys and materials often resemble junk rooms and doom the play therapy process to failure. Toys and materials should be carefully selected for (a) the contribution they make to accomplishing the objective of play therapy, and (b) the extent to which they are consistent with the rationale for play therapy.

All play materials do not automatically encourage the expression of children's needs, feelings, and experiences. Simple, easy-to-use toys encourage success and mastery and provide opportunities for children to express a wide variety of experiences and the accompanying feelings. Highly structured materials and mechanical toys should be avoided in general because they may interfere with, rather than facilitate, children's expressions. Because the child uses toys and materials in the act of play to communicate a personal world to the play therapist, consideration should be given to selecting toys and materials that facilitate the following goals (Landreth, 1991):

1. Establishment of a positive relationship with the child

2. Expression of a wide range of feelings

3. Exploration of real-life experiences

4. Testing of limits

5. Development of a positive image

6. Development of self-understanding

7. Opportunity to redirect behaviors unacceptable to others.

The following toys and materials represent the minimum requirements and are recommended because they encourage a wide range of expressions and can be easily transported in a tote bag or stored out of the way in a corner or in a closet for therapists who do not have an entire room to devote to a permanent playroom. They can be grouped into three broad categories.

1. Real-life toys, such as a doll (small size with soft body); a bendable doll family; a small cardboard box with rooms indicated by strips of tape or felt pen marker (could double as container for materials); doll house furniture; a plastic nursing bottle; a pacifier; two play dishes and cups; spoons; a small car; a small airplane; and a telephone.

2. Acting-out or aggressive release toys, such as handcuffs (spring-release type without key), a dart gun, 4foot length of rope, toy soldiers (30-count size with two different colors of soldiers); aggressive puppets (such as an alligator or dragon); a pounding bench; a rubber knife. An inflatable punching bag is a good item if space permits.

3. Toys for creative expression and emotional release, such as crayons (8-count size to avoid too many choices; break some in two and peel paper off to convey that they do not have to be neat and precise); newsprint; blunt scissors; an assortment of craft materials, such as pipe cleaners, popsicle sticks; Play-Doh; hand puppets; a small, plain mask (Lone Ranger type); a Nerf ball; Gumby (bendable, nondescript figure); scotch tape; nontoxic glue or paste; an empty vegetable can (doubles as a container for toy soldiers). If space permits, a sandbox or sandtray and a container of water are desirable additions to this category.

Play therapists who have a permanent place for play therapy can add toys and materials. Landreth (1991) has provided a complete list of play materials for a fully equipped play therapy room.

Playroom Considerations

With the appropriate selection of toys, play therapy can be conducted in a variety of locations and spaces. The space must provide privacy from view, and, if possible, be located $where noises from the playroom don't travel to the waiting room, adjoining classrooms, or offices. Parents, teachers, and administrators, who may not fully understand the value of children expressing their emotional world through play, are often unduly concerned by noises they hear coming from the playroom.

Although not mandatory, a room approximately 12 feet by 15 feet dedicated for use as a playroom seems to best meet the purposes of play therapy. A room of this size allows ample space for movement and exploration without the child ever being too far away from the therapist, and it provides adequate space for group play therapy for two or three children. A sink with cold running water is highly recommended. It provides opportunities for water-play activities and also facilitates the clean-up of messes. Children in play therapy need opportunities to make messes; therefore, ease of cleaning is a primary consideration in selecting floor and wall coverings.

An office with carpet and unwashable wall paint imposes limits on the child's behavior and limits the use of "messy" play media-both of which may limit the child's full expression. When this is the only space available to the play therapist, clear sheets of plexiglass can be placed under sandboxes, easels, and the like, and attached to the wall to protect the office.

If funds permit, a one-way mirror and videotaping equipment provides opportunities for training and supervision and is desirable. As in the case of filial/family play therapy, the one-way mirror is helpful in the training and supervision of parents as they learn to apply play therapy skills with their own children. Videotaping of play sessions also protects the play therapist, as there is no question about what took place during the play therapy session. When designing a new playroom, the addition of a small bathroom with just enough space for a commode eliminates the problems associated with children having to leave the playroom to go to the bathroom.

THE PROCESS OF PLAY THERAPY

The play therapy process can be viewed as a relationship between the therapist and the child in which the child utilizes play to explore his or her personal world and also to make contact with the therapist in a way that is safe for the child. The child's world is a world of action and activity. Play therapy provides an opportunity for children to live out, during play, past experiences and associated feelings. This process allows the therapist to experience, in a personal and interactive way, the inner dimensions of the child's world.

This therapeutic relationship is what provides dynamic growth and healing for the child.

Axline (1947) succinctly clarified the basic principles that provide guidelines for establishing a therapeutic relationship and making contact with the inner person of the child in the play therapy experience. Landreth (1991) revised and extended these eight basic principles as follows:

1. The therapist is genuinely interested in the child and develops a warm, caring relationship.

2. The therapist experiences unqualified acceptance of the child and does not wish that the child were different in some way.

3. The therapist creates a feeling of safety and permissiveness in the relationship so the child feels free to explore and express himself or herself completely.

4. The therapist is always sensitive to the child's feelings and gently reflects those feelings in a manner that encourages the child to develop self-understanding.

5. The therapist believes deeply in the child's capacity to act responsibly, unwaveringly respects the child's ability to solve personal problems, and allows the child to do so.

6. The therapist trusts the child's inner direction, allows the child to lead in all areas of the relationship, and resists any urge to direct the child's play or conversation.

7. The therapist appreciates the gradual nature of the therapeutic process and does not attempt to hurry the process.

8. The therapist establishes only those therapeutic limits that help the child accept personal and appropriate responsibility for the relationship. (pp.77-78)

Objectives of Play Therapy

Play therapy is a learning experience for children and, as such, is viewed from a developmental perspective with an overall objective of assisting children to learn about themselves and their world. According to Axline (1947), play therapy furthers the development of children by helping them learn to know and accept themselves.

The primary objective in play therapy is not to solve the problem but, rather, to help the child grow. When the focus is on solving the problem, the child as a person usually gets lost in the process. The child is most important, not the problem. The following initial objectives of play therapy outlined by Landreth (1991) are appropriate regardless of the therapist's theoretical orientation.

1. To establish an atmosphere of safety for the child. The play therapist cannot make children feel safe. Children discover that for themselves in the developing relationship. Children cannot feel safe in a relationship that contains no limits. Safety is also promoted by the therapist's consistency.

2. To understand and accept the child's world. Acceptance of the child's world is conveyed by being eagerly and genuinely interested in whatever the child chooses to do in the play room. Acceptance also means being patient with the pace of the child's exploration. Understanding is accomplished by relinquishing adult reality and seeing things from the child's perspective.

To encourage the expression of the child's emotional world. Although the play materials are important, they are secondary to the feelings they promote in the child. Play therapy requires an absence of evaluation of feelings. Whatever the child feels is accepted without judgment.

4. To establish a feeling of permissiveness. This is not a totally permissive relationship. Nevertheless, the child has to feel or sense the freedom available in this setting. Allowing children to make choices for themselves creates a feeling of permissiveness.

To facilitate the child's decision making, This is accomplished largely by refraining from being a source of answers for the child. The opportunity to choose what toy to play with, how to play with it, what color to use, or how something will turn out creates decision-making opportunities, and with decision making comes self-responsibility.

6. To provide the child an opportunity to assume responsibility and to develop a feeling of control. Although actually being in control of one's environment is not always possible, an individual has to feel in control. Children are responsible for what they do for themselves in the playroom. When the play therapist does things for children that they can do for themselves, children are deprived of the opportunity to experience what self-responsibility feels like.

To put into words what is experienced and observed in the child's behavior, words, feelings, and activity. Through the process of accurately labeling the child's emotions, the play therapist teaches the child an emotional language, thereby providing the child an additional means of communication. (pp. 154155)

Structuring the Relationship

For most children, the therapeutic relationship is like no other they have experienced-one in which they are fully accepted and valued for who they are. The play therapist maintains and communicates a constant regard and respect for children regardless of their behavior. The structuring of the relationship begins with the initial interactions between therapist and child in the waiting room. The therapist's task is to give full attention to the child, rather than to the parents-communicating the child's importance. Therefore, prior to the first play session, the play therapist should meet with the parents without the child present.

The initial parent consultation provides the play therapist with the opportunity to inform parents what they need to know about play therapy and what to expect during the process. The therapist's primary task during this session is to focus entirely on the parents' needs and concerns, conveying to them their importance in their child's therapy.

More important, having met with the parents, the therapist now is free to focus entirely on the child when they first meet. In this initial meeting between therapist and child, the therapist should crouch down, make eye contact, and greet the child. Following a short introduction, the therapist can say, "We can go to the playroom now. Your mom (or the person who brought child) will wait here so she will be here when we come back from the playroom."

The play therapy relationship is further structured by how the therapist introduces the child to the play room. Verbal communication should be kept to a minimum at this point. No amount of words will convey to the child that this is a safe place. The child learns this through experience. The therapist should choose words carefully to communicate to the child freedom, self-direction, and the parameters of the relationship. The therapist might say something like, "Sarah, this is our playroom, and this is a place where you can play with the toys in a lot of the ways you would like to." This statement conveys responsibility for direction, freeing the child. Boundaries on this freedom are conveyed by the words "in a lot of the ways," which in effect communicates limits on behavior. The playroom is not a place of complete freedom where children can do anything they want.

Facilitative Responses

The natural response of many adults to children is to question, provide answers, and solve their problems for them. The play therapist genuinely believes children are capable of figuring out things for themselves, within the boundaries of their developmental capabilities. From this new perspective, children are viewed as capable, creative, resilient, and responsible. Responding to children in a way that communicates sensitivity, understanding, and acceptance and conveys freedom and responsibility requires a drastic shift in attitude and a restructuring of responses for most therapists as they learn to respond therapeutically to children. As with other therapeutic dimensions, the therapist's attitude is critical in making contact with children in such a way that they feel understood and accepted. The play therapist's empathic responses to feelings, thoughts, and play behaviors communicate understanding and acceptance, freeing the child to be more creative and expressive.

Facilitative responses in play therapy should be short and interactive, so the child can easily understand what the therapist is communicating. Perhaps more important, the child needs to know that he or she has been understood and accepted. Children begin to recognize their intrinsic inner value, as opposed to what they produce or accomplish, when the play therapist responds sensitively to that part of their person by accepting and reflecting nonverbally expressed feelings. Evaluative responses deprive the child of inner motivation and should be steadfastly avoided.

Facilitative responses return responsibility for direction and solution to the child and allow the child to lead in determining content and focus. Allowing a child the freedom to engage in the decision-making process provides opportunities for the child to struggle with ownership and responsibility. In the process of returning responsibility, the child learns self-direction and develops creative resiliency.

Setting Limits in Play Therapy

Limit setting is a necessary and vital part of the play therapy therapeutic process. Although the procedures for setting limits may vary, the setting of therapeutic limits is part of all theoretical approaches to play therapy. The structure of therapeutic limits is what helps to make the experience a real-life relationship. Limits in play therapy have both therapeutic and practical benefits in that they preserve the therapeutic relationship, facilitate the child's opportunities to learn self-responsibility and self-control, among many other dimensions, and provide the child and the therapist with a feeling of emotional security and physical safety. This feeling of emotional security enables a child to explore and express inner emotional dimensions that perhaps have remained hidden in other relationships.

The purpose for setting limits can be summarized as follows:

1. Limits define the boundaries of the therapeutic relationship.

2. Limits provide security and safety for the child, both physically and emotionally.

3. Limits demonstrate the therapist's intent to provide safety for the child.

4. Limits anchor the session to reality.

5. Limits allow the therapist to maintain a positive and accepting attitude toward the child.

6. Limits allow the child to express negative feelings without causing harm and the subsequent fear of retaliation.

7. Limits offer stability and consistency.

8. Limits protect the play therapy room.

9. Limits provide for the maintenance of legal, ethical, and professional standards.

Play therapy is not a completely permissive relationship because children do not feel safe, valued, or accepted in a relationship without boundaries. Boundaries provide predictability. Therefore, children are not allowed to do anything they want to do. A prescribed structure provides boundaries for the relationship that the play therapist has already determined are necessary. Limits should be set on harmful or dangerous behavior to the child and therapist behavior that disrupts the therapeutic routine or process (continually leaving the playroom, wanting to play after time is up)

- destruction of room or materials

- taking toys from the playroom

- socially unacceptable behavior

- inappropriate displays of affection.

As can be readily seen in this list, the play therapy relationship has minimal limits. Messiness is accepted, exploration is encouraged, neatness or doing something in a prescribed way is not required, and persistent patience is the guiding principle. The child's desire to break the limit is always of greater importance than actually breaking a limit.

Because play therapy is a learning experience for children, limits are not set until they are needed. The child cannot learn self-control until an opportunity to exercise selfcontrol arises. Therefore, placing a limitation on a child pouring paint on the floor is unnecessary unless the child attempts such an activity. Limits are worded in a way that allows the child to bring himself or herself under control. The objective is to respond in such a way that the child is allowed to say "No" to self. "You would like to pour paint on the floor, but the floor is not for pouring paint on; the pan on the table is for pouring paint into" recognizes the child's feeling, communicates what the floor is not for, and provides an acceptable alternative. The child thereby is allowed to stop himself or herself. The therapist always states limits in a calm, patient, matter-of-fact, firm, and specific way.

WHAT CHILDREN LEARN IN PLAY THERAPY

Play therapy assists children's development by helping them learn to know and accept themselves. Most of what is learned in the play therapy relationship is not cognitive learning, rather, experiential, intuitive learning about self that occurs over the course of therapy. Landreth (1991) described the following learning experiences.

1. Children learn to respect themselves. The play therapist maintains and communicates constant regard and respect for children regardless of their behavior, whether they are playing passively, acting out aggression, or being whiny and insisting on help with even the simplest tasks. Children sense the therapist's respect, feel respected, and, because of the absence of evaluation and an ever present acceptance, they internalize the respect. Once children have respect for themselves, they learn to respect others.

2. Children learn that their feelings are acceptable. By playing out their feelings in the presence of an adult who understands and accepts even the intensity of the feelings, children learn that all of their feelings are acceptable. As children begin to experience that their feelings are acceptable, they begin to be more open in expressing them.

Children learn to express their feelings responsibly. Once children have expressed their feelings openly and been accepted, they lose their intensity and can more easily be controlled appropriately. This, then, is a freeing process for children to experience in that they are free to go beyond those feelings.

Children learn to assume responsibility for self. In the natural process of development, children strive toward independence and self-reliance but often are thwarted in their efforts by adults who, although well intentioned, take charge by doing things for children and thus deprive children of opportunities to experience how being responsible for self feels. In the play therapy relationship, the therapist believes in children's ability to be resourceful and so resists doing anything that would deprive children of the opportunity to discover their own strength. As the therapist allows children to struggle to do things for themselves, they discover what that responsibility feels like.

5. Children learn to be creative and resourceful in confronting problems. When children are allowed to figure out things for themselves, to derive their own solutions to problems, to complete their own tasks, their own creative resources are released. With increasing frequency, then, children will tackle their own problems and experience the satisfaction of doing things all by themselves. Although children may at first resist the opportunity to solve their own problems, the creative tendency of the self will come forth in response to the therapist's patience.

6. Children learn self-control and self-direction. If no opportunities are available to experience being in control, learning self-control and self-direction is not possible. Although this principle seems simplistically obvious, the absence of opportunities like this in children's lives is conspicuous when one takes the time to carefully observe children's interactions with significant adults.

Unlike most other adults in children's lives, the play therapist does not make decisions for children or try to control them either directly or subtly. Limits on children's behavior in the playroom are verbalized in such a way that children are allowed to control their own behavior. Because control is not applied externally, children are able to make their own decisions.

Children gradually learn, at a feeling level, to accept themselves. As children experience being accepted just as they are with no conditional expectations from the therapist, they gradually, and in sometimes imperceptible ways, begin to accept themselves as worthwhile. This is both a direct and an indirect process of communication and learning about self. Acceptance is an attitudinal message communicated through the therapist's total behavior by all that the therapist is and does in and through interactions with the children. The children first feel acceptance and then know it by being accepted nonjudgmentally for who they are, just as they are, with no desire that they be different. This increased self-acceptance is a major contributing factor to development of a positive self-concept.

8. Children learn to make choices and to be responsible for their choices. Life entails a never-ending series of choices. How can children learn how to make a choice if they are not afforded the opportunity of making choices, being indecisive, the struggling, wanting to avoid, feeling incapable, being anxious, and apprehensive that one's choice will be unacceptable to other? Therefore, the therapist avoids making even simple choices for children.

CHILDREN IN PLAY THERAPY

The following brief excerpts from two cases illustrate the facilitative dimensions of using a play therapy approach. They demonstrate the process of exploration possible when children are afforded a medium of expression with which they feel comfortable.

Debbie: The Little General

Debbie, age 6, was referred to the therapist for being manipulative in her relationships with her parents and teacher. Her parents described Debbie as "bossy" and having difficulty getting along with other children. The following excerpt from her play therapy session is an example of several of her attempts to manipulate the therapist.

Debbie (seated at the table painting): Get those paints and bring them over here. I want to use them. (Debbie was actually closer to the paints.)

Therapist: I know that you want me to get the paints for you, but in here you can get the paints if you want them.

Debbie: But I'm busy. Can't you see that?

Therapist: You're just so busy that you want me to get them for you.

Debbie: Yes! Now would you just hand me the paints!

Therapist: You're angry because I won't get the paints for you, but that's something you can do if you want the paints. (Debbie got up, retrieved the paints, and proceeded to paint.)

The presence of the toys and materials allowed Debbie, in the immediacy of the relationship with the therapist, to exhibit a significant behavior for which she had been referred. Thus, the therapist was able to demonstrate acceptance of Debbie's anger and to relate in a matter of fact way to the deeper issue of her doing things for herself. Debbie was given an opportunity to act immediately on her decision to get the paints for herself-an initial step toward selfresponsibility. In the absence of the materials, Debbie could only have talked about what she would do later outside the therapist's office.

The following excerpt is from Debbie's second play therapy session. She had been painting at the table for several minutes. The therapist was seated across the table. At one point Debbie moved her paintbrush from the paper to a paint container for more paint, and the therapist's head turned slightly to follow the movement of the brush.

Debbie: Without moving your head, you can watch me paint at the same time.

Therapist: Some of the things I do bother you sometimes.

Debbie: Yes. (Moves paintbrush back and forth rapidly in front of the therapist's face, obviously trying to get the therapist to watch the brush. Debbie grins broadly.)

Therapist: I guess you were wondering, then, if I would play a game with you.

Debbie: Uh-hmmm.

Therapist: And I just decided I would watch you. (Debbie giggles and sticks paintbrush toward therapist.)

Debbie: I fooled you, didn't I? You thought I was going to paint on you. (Big grin on her face)

Therapist: You like to fool people sometimes.

Debbie: I like to fool you.

Therapist: Oh, you just like to fool me.

Debbie: Right. I can't fool Susan because she's my cousin and she don't like it.

Therapist: She doesn't like you to play games with her.

Debbie: No, uh, she don't like me playing tricks on her.

Therapist: Uh-hmmm.

Debbie: But Robin don't mind.

Therapist: So with some people it's okay, and with some people it's not.

Debbie: Uh-hmm. Robin's my favorite because Janie won't let me do that.

Therapist: You really like people who will let you play tricks on them.

Debbie: Uh-hmm. Robin's my best one because she don't say anything. (Continues to paint)

In the second episode, use of the materials stimulated an exchange between Debbie and the therapist that resulted in Debbie's openly expressing liking for only those children who would allow her to manipulate them. This expression is the beginning to self-understanding. The reality testing made possible by the presence of toys and materials makes play therapy a powerful therapeutic approach in the lives of children (Landreth, 1987, p. 258).

Kate: From Terrible to Terrific

Kate, almost 4 years old, was referred to play therapy for temper tantrums, extreme mood swings, and acting-out, impulsive behavior. The initial consultation with Kate's parents revealed their desperation in getting help for their daughter. Kate was under the care of a child psychiatrist who had diagnosed Kate with attention deficit hyperactivity disorder, prescribing both Ritalin and Tegratol to treat her behavioral symptoms. Kate was described as being a sweet, loving child one moment and a "holy terror" the next. Kate's mother had recently quit work to stay home with her after Kate had been "expelled" from three child care centers for being "out of control."

Kate's first two play therapy sessions were characterized by an inability to focus on any of the toys long enough to play. She was highly anxious and difficult to understand. She talked nonstop, her sentences made up of seemingly disconnected thoughts. The following excerpts illustrate Kate's impulsivity and distractibility and her struggle with learning to control her own behavior.

In the second session, as she looked in the mirror, Kate sat on the table by the door and began telling the therapist about a party.

Kate: MY cousin . . . uhh . . . uhh . . . she had a Dart and we . . . see (Kate leans over toward the therapist, smiles, and points to the lipstick on her lips.)

Therapist: You wanted me to see that. (This response acknowledges Kate's desire to make contact with and involve the therapist.)

Kate: (Nodding) It's my . . . (Kate is distracted by a hat she sees on the shelf, reaches over to pick it up and quickly puts it on, discovering a whistle on a string that is attached to the hat.) What's this? (Without waiting for an answer, she immediately puts the whistle in her mouth and blows several times.)

Therapist: You decided it was for blowing. (Kate obviously knew what to do with the whistle; this response gives her credit and also conveys to Kate that she could have decided to do something else with it.)

Kate: (Blowing the whistle several more times and smiling) It's like the party . . . (Kate uses her hand to demonstrate something.) It goes like . . . (Using her hand to demonstrate the same thing again, obviously enjoying herself.)

Therapist: You really like that. (Even though the therapist didn't have any idea what Kate was doing, it obviously was something she enjoyed.)

These excerpts from the second session demonstrate the therapist's understanding and acceptance of Kate. Even though Kate's verbalization was disjointed and difficult to understand, the therapist was able to respond to the underlying feelings by focusing on Kate's facial expressions and her tone of voice.

In the third session, Kate began a weekly ritual of painting in which she would begin by letting the therapist know that she couldn't get messy and that her painting wouldn't be messy. Painting was the first activity that Kate was able to focus on for more than a few minutes.

Kate: (After the therapist had informed Kate that she had 5 minutes left in the playroom) Can I use these? (While touching two paintbrushes and looking at the therapist.)

Therapist: You can if you want to. (Response returns responsibility to Kate to make the decision if she wants to paint.)

Kate: I can't get my new clothes dirty. (Immediately begins to paint with two brushes.)

Therapist: You decided you wanted to paint. (Response acknowledges her decision to paint.)

Kate: (Putting lots of paint on the paper) It won't be very messy. It's going to be for my mommy. I'm just going to put some more paint on the bottom, but it won't be very messy (Putting every color on the paper and mixing them all together-the paint so thick that it begins to run off the paper.) I'm just gonna put some more up here. (Making sure there isn't any unpainted spot left on the paper.)

Therapist: You like to use lots of paint. (Response focuses on Kate's enjoyment of the paint, rather than the message that it's not okay to be messy.)

Kate: (Nods) Yeah, I do. It's gonna be a little messyjust around the edges.

Therapist: You decided it's okay if it's a little messy. (Response gives Kate the freedom and responsibility to decide how she wants her painting to be and also conveys acceptance of her "messiness.")

Therapist: Kate, we have one minute left in the playroom, and then it will be time to go back to the waiting room. (Response acknowledges that children need to have time to prepare themselves to leave the playroom.)

Kate: (Begins to hurriedly put more paint on the picture, accidentally getting paint on her hand.)

Therapist: You had something else in mind you wanted to do to your painting before our time was up. (Response touches on the urgency of Kate's actions in response to the 1-minute warning, acknowledges that she had a plan in mind, and gives Kate the responsibility for her actions.)

Kate: (Impulsively, Kate takes the brush and paints the hand that has paint on it, begins to make handprints on her painting, and then takes both hands and mixes all the paint together on her painting until the entire painting is brownish-black.)

Therapist: Kate, our time in the playroom is up for today (therapist rises out of the chair). (Response conveys both physically and verbally that time is up. Adhering to the same time limit each week is important. Children need consistency, predictability, and security in their lives.)

Kate: (Continues to mix paints with hands) I just need to finish with this part.

Therapist: Kate, I know you'd like to paint some more, but our time is up for today. You can paint some more next week. (Response recognizes Kate's desire to stay and paint but clearly conveys the limit that time is up, providing her with an alternative.)

Kate: I just need to do . . . (Continuing to mix the paint with her hands, obviously caught up in the sensory experience of the paint on her hands.)

Therapist: Sometimes it's just really hard to stop when you're having fun, but, Kate (using firmer voice), our time in the playroom is over for today. When you come back next week, you can choose to paint some more. (Response acknowledges Kate's difficulty in stopping herself. The limit is firmly set a second time, but the therapist is patient, allowing Kate to struggle with leaving of her own accord.)

Kate: (Noticing the paint all over her hands, she goes to the sink and tries to turn on the water, but her hands are slippery with paint. Kate looks at the therapist.)

Therapist: (Walking over to the sink) It's hard to turn the water on with paint on your hands.

Kate: I don't want paint on my hands. (She is working hard to get all the paint off.)

Therapist: It's really important to you to get all the paint off, but it's time for us to leave now. (Therapist walks toward door. Kate leaves the water running and runs to the door.)

Excerpts from the third session illustrate Kate's struggle with self-control and impulsivity demonstrated through her painting and difficulty in leaving the playroom. The therapist's responses convey acceptance of Kate for who she is, whether messy or clean, and convey a belief in Kate's ability to control her own behavior.

Kate's themes of self-control/out of control and messy/ clean continued to be played out over the next 27 sessions. For the next 22 weeks Kate started every painting by saying some version of. "This painting's not gonna be too messy," and every week her painting ended up with all the colors mixed together to make a brownish-black, without one unpainted space on the paper.

As the 20 weeks progressed, Kate displayed more planning and less impulsivity in the process of painting, although the final product looked the same. She often asked the therapist in the middle of her painting, "Do you like it? Don't you think it's cute?" The therapist's responses varied from, "You like your painting-you think it's cute" to "Kate, in here what's important is what you think." These responses helped Kate develop an internal locus of evaluation, rather than relying on an external source of validation. An internal locus of evaluation is a prerequisite for internal locus of control, or self-control.

In week 26, Kate produced her very first painting in which the colors were not mixed together, but she continued to fill every inch of the paper. In week 27, Kate again did not mix the colors on her painting and for the first time was able to leave some unpainted space on the paper. After finishing it, Kate stepped back and studied it as if she were Van Gogh and announced, "I like it. It's very cute!"

In week 28, Kate came into the playroom and announced, "I'm going to paint a rainbow today." She proceeded to paint a rainbow (with lots of paper left unpainted) but then painted over it with black because two of the colors of the rainbow were mixed together. For the first time in 28 sessions Kate said she was going to paint another picture and proceeded within just a few minutes to paint an identical rainbow, except none of the colors were mixed. She stepped back, looked at her rainbow for a few minutes and said matter-of-factly, "I'm through," and went over to play in the sandbox. This was the last time Kate painted.

In weeks 29 and 30 Kate no longer needed to paint and busied herself preparing to terminate. Painting was not the only activity that Kate utilized in play therapy. She exhibited similar themes throughout her play. In the final consultation with Kate's parents, they were happy to report that their daughter, whom they had once described as stuck in the "terrible two's," was now a "terrific four" (most of the time).

By using a play therapy approach, child therapists convey to children their willingness to accept children as they are. Play is a way of being, a way of relating, a vehicle of communication, and a form of personal expression. Through the process of acting out a living relationship with the therapist, children experience the meaning of self-responsibility, explore alternative behaviors that are more satisfying, and discover new dimensions of themselves that result in revised self-images and new behaviors.

PLAY THERAPY RESEARCH AND RESULTS

Play therapy is not an approach based on guess, trial and error, or whims of the play therapist at the moment. Play therapy is a well-thought-out, philosophically conceived, developmentally based, and research-supported approach to helping children cope with and overcome the problems they experience in the process of living their lives. Play therapy has been demonstrated to be an effective therapeutic approach for a variety of children's problems including, but not limited to, the following areas (Landreth, Homeyer, Glover, & Sweeney, 1996):

The popular myth that play therapy requires a long-term commitment for many months is unfounded, as is shown in case studies and research reports reported by Landreth, Homeyer, Glover, and Sweeney (1996) in their book Play Therapy Interventions with Children's Problems.

PROFESSIONAL TRAINING

Prospective play therapists have to be adequately trained. Most play therapists have a master's degree in counseling, psychology, or social work, although other disciplines also are represented in the field. A master's degree representing some area of the helping profession with emphasis on the clinical or counseling aspects of therapeutic relationships is a general prerequisite. Within or in addition to such a program, training should incorporate the areas of child development and basic counseling skills including acquisition of a theoretical approach incorporating a rationale for behavior change consistent with the play therapy approach utilized. The program of study should include extensive training in the area of play therapy and a supervised practicum experience with children in play therapy.

FUTURE TRENDS IN PLAY THERAPY

The field of play therapy is growing and is now represented by the Association for Play Therapy, an international professional organization. A National Center for Play Therapy has been established at the University of North Texas. Increasing numbers of elementary school counselors and therapists in private practice and agencies are incorporating play therapy into their work with children. There is a trend toward family therapy to address social and emotional values of developmental as well as family group cohesion issues. In filial therapy, parents are trained to use play therapy procedures with their children. This method is well researched and has proven to be effective in ameliorating children's problems through enhancing the parent-child relationship.

CONCLUSION

Play therapy is based on developmental principles and, thus, provides, through play, developmentally appropriate means of expression and communication for children. Therefore, skill in using play therapy is an essential tool for mental health professionals who work with children. Therapeutic play allows children the opportunity to express themselves fully and at their own pace with the assurance that they will be understood and accepted.

REFERENCES

Alexander, E. D.(1964). School centered play therapy program, Personnel & Guidance Journal, 43, 256-261.

Axline, V. M. (1947). Play therapy: The inner dynamics of childhood. Cambridge, MA: Houghton Mifflin.

Axline, V.M. (1950). Entering the child's world via play experiences, Progressive Education, 27, 68-75.

Dimick, K. M., & Huff, V. E. (1970). Child counseling. Dubuque, IA: Wm. C. Brown.

Frank, L. (1982). Play in personality development. In G. Landreth (Ed.), Play therapy: Dynamics of the process of counseling with children (pp. 19-32). Springfield, IL: Charles C. Thomas.

Froebel, F. (1903). The education of man. New York: D. Appleton.

Landreth, G. L. (1972). Why play therapy? Texas Personnel & Guidance Association Guidelines, 21, 1.

Landreth, G. (1987). Facilitative use of child's play in elementary school counseling. Elementary School Guidance & Counseling Journal, 21(4), 253-261.

Landreth, G. L. (1991). Play therapy: The art of the relationship. Accelerated Development.

Landreth, G. L., Homeyer, L., Glover, G., & Sweeney, D. (1996). Play therapy interventions with children's problems. Northvale, NJ: Jason Aronson.

Landreth, G. L., Jacquot, W. & Allen, L., (1969). A team approach to learning disabilities, Journal of Learning Disabilities, 2, 82-87.

Muro, J. J. (1969). Play media in counseling: A brief report of experience and some opinions, Elementary School Guidance & Counseling Journal, 2, 104-110.

Myrick, R. D., & Holdin, W. (1971). A study of play process in counseling. Elementary School Guidance & Counseling Journal, 5, 256-265.

Nelson, R. C. (1966). Elementary school counseling with unstructured play media, Personnel & Guidance Journal, 45, 24-27.

Piaget, J. (1962). Play, dreams, and imitation in childhood. New York: Routledge.

Rousseau, J. J. (1930). Emile. New York: J. M. Dent & Sons. (originally published 1762)

Waterland, J. C. (1970). Actions instead of words: Play therapy for the young child, Elementary School Guidance & Counseling Journal, 4r 180-197.

Garry Landreth is a Regents Professor in the Department of Counseling, Development and Higher Education, and Director of the Center for Play Therapy, University of North Texas, Denton. Sue Bratton is an Assistant Professor in the Department of Counseling, Development and Higher Education and Co-Director of the Child and Family Resource Clinic, University of North Texas, Denton.

Copyright Love Publishing Company Sep 1998
Provided by ProQuest Information and Learning Company. All rights Reserved