Foundations of the Play Therapy Relationship

Ann Beckley-Forest, LCSW-R, RPT-SClinical Social Worker and Registered Play Therapy SupervisorBuffalo, New York, USAEmail: ann.beckleyforest@gmail.comwww.annbeckleyforest.com

Children– Play is the reason!

‣ Using insight-oriented psychotherapy or traditional cognitive-behavioral therapy with children – results are often disappointing • Story of Wilson, age 9

Reasoning with the Unreasonable!

Remembering what we know alreadyChildren and young adolescents are fundamentally different from adults:‣ cognitively ‣ emotionally ‣ tactile and kinesthetic learners‣ experimental learners= play is the experiment.‣ Adults are experiential learners, too!!

Early ideas about play…“You can discover more about a person in an hour of play than in a year of conversation.”

Plato(427-437 BC)

“Play is the highest expression of human development in childhood, for it alone is the free expression of what is in a child’s soul.” –Friedrich Froebel, 1885Founder of “Kindergarten”

Tradition of understandingplay as the way children learn and express

‣ Anna Freud (1920-40s)◦ Play is not trivial, it’s the way

children express their internal world

◦ Healthy emotional development depends upon children learning to manage difficult feelings

‣ John Dewey‣ Children are constantly learning

through their actions, and reflecting on their experiences

Theoretical Models for understanding children’semotional disturbance

Family Systems Attachment

Temperament Developmental

Trauma-informed

Developmental‣ Social-emotional maturation is the focus‣ Especially relevant for autism-spectrum and

organically based disorders, such as ADHD

Play therapy offers:‣ Diagnostic and descriptive insights‣ Game-based corrective experiences

‣ Theraplay, directive play therapy interventions

Attachment‣ Sees emotional problems in context of adequacy of

attachment needs being met in infancy and early childhood

Play Therapy offers:‣ Corrective experiences to learn attachment

behaviors‣ Interventions for the parent-child dyad

‣ Theraplay (Jernberg and Booth)‣ Parent-Child Interaction Therapy‣ Developmental Play Therapy (Brody)

Temperament‣ Genetic or organic “nature” of the child

• Easy/Flexible, Difficult/Active, Cautious‣ Considers “goodness of fit” between

child’s temperament and the caregivers/environment

Play therapy offers:Flexibility of intervention in a child-centered play therapy environmentAttunement to the child’s viewParent- child dyad approaches

Family Systems‣ Views the child’s behavior in the context of the

family – child’s symptoms often seen as meeting the needs of adults in the family system in some way

Play therapy offers: ‣ actively engage the child in the healing process,

versus focusing on verbal processing with the whole family – which tends to primarily engage the parents

Names: Landreth (filial play therapy) and Gil (family puppet story), Adlerian family play (Kottman)

Trauma-informed‣ Sees earlier traumatic and upsetting events and the

brain/body’s response to these as the key to understanding reactivity and symptoms

‣ Strong body of empirical evidence to support controlled exposure to these memories and reprocessing them as the key to healing

Play therapy offers‣ A way for children to reprocess these experiences

and correct negative beliefs using gradual exposure in play

‣ Names: Axline, Gil, Goodyear-Brown, etc.

History of Play Therapy‣ 1950s: Carl Rogers : person-centered theory of the personality

‣ 1960s: Virgina Axline adapted Rogerian ideas to work with children in non-directive play therapy -- projecting emotional process using toys as materials

Famous text: Dibs in Search of Self

‣ 1970s: Child Guidance centers in major universities, research expands.• Gary Landreth: The Art of the Relationship

‣ 1980-90s: play therapy practice becoming standardized under international associations in North America, Europe, Australia

‣ 2000s play therapy standardized research, global reach

What its not – “just playing”‣ Materials are selected on the basis of their

usefulness in capturing the child’s emotional landscape, allowing for projection, externalization, and mastery experiences

‣ Therapist participation is deliberate and based on treatment goals for the child

Core Therapeutic Powers of Play(graphic by J. Powers adapted from Schaefer & Drewes, 2014)

• Therapeutic relationship

• Attachment• Social competence• Empathy

• Problem solving• Resiliency• Moral development• Accelerated

psychological development

• Self-regulation• Self esteem

• Catharsis• Abreaction• Positive emotions• Counter-conditioning

fears• Stress inoculation • Stress management

• Self-expression• Access to the

unconscious• Direct and indirect

teachingFacilitates

communication

Fosters emotional wellness

Enhances social

relationship

Increases personal strengths

Goals of the Play Therapy relationship

Safety and alliance

Understand the child’s

world

Empowerment

Active learning

What Play Therapy looks like‣ Common elements : Materials

• Sand tray and miniatures

Miniatures: domestic and landscapeHousehold: children,animals, adults, food, beds/furniture

Landscape: fences, bridge, rock, fire, tree, food

Miniatures: aggression themes

Puppets• Useful with younger

children• Versatile – many

different possibilities• Help children find a voice• Helps therapist

communicate new ideas in a more engaging way

Role play• More embodied, “closer

in” to the feelings• Master sensory

experiences, fears• Perspective-taking,

empowerment

Interactive and expressive materials:‣ Balls, blankets, pillows for sitting on‣ Art supplies: markers, crayons, clay, paint, paper‣ Doll house for domestic scenes

Some play therapy rooms

What play therapists look like

Less formal, more playfulSit at the child’s levelComfortable with kids!

Play therapy continuum‣ Therapist leads‣ Child responds

‣ Mastery through game-based learning based on therapist’s assessment of needs

Child Centered

Child-responsive

Directive play therapy

Child leads Therapist

influences and responds

Therapist invites mastery experiences within the play

Child leads Therapist supports

through neutrality

Child uses environment to create own mastery experiences

Methodology: Child-centered play therapy‣ Emphasizes safe space and empowerment‣ Child is shown the environment and told: “you can

use these things any way you want to”‣ Therapist’s stance is unconditional support‣ Therapist’s role: tracks and notices aloud the

child’s actions in play.‣ Therapist avoids taking a stand

Building of a non-hierarchical relationship in the play therapy room

The words of child centered play

You are decidingwhat you want to do

(empowers)

I see the big one is chasing that little one

(descriptive)

That little dinosaur might

feel scared(attune and verbalize)

I am letting you know that no one gets hurt when we

play (set limits)

Setting limits in Child-centered play therapy (Landreth)

A • Acknowledge the feeling

C• Communicate the limit

T • Target acceptable alternatives

Dynamic child-centered play for mastery

Methodology: Child-Responsive play therapy‣ Therapist builds on established safety and rapport,

goals‣ Many elements of child-centered play are present,

but therapist stance may include a “coach” role, or may take over the narrative or enter the play strategically

‣ Therapist may invite child in a new direction, try to “shift the metaphor” of the play

‣ I wonder….

Sand tray as the safe container for processing“the divorce before and after”

“A town divided”

Methodology: Directive play therapy‣ Uses games and planned interactions and activities to

teach skills and accomplish goals‣ Educational approach‣ Builds on established evidence-based approaches such as

CBT‣ Can promote healing in areas the child might otherwise

avoid (such as trauma)‣ Still high need for therapist flexibility, creativity an

attunement for success

‣ The more directive the activity, the greater potential for emotional flooding and activating the “defiance” dynamic

Resistance and Defiance‣ Regulates distance‣ Communicate emotional flooding‣ Communicate information about attachment

insecurity‣ Child is not in a “choosing mind” (in primitive

survival mode)

Stomp the Worry Bully: A directive play therapy activity for anxious kids

1. Create an image of the worry monster who gives you the yukky thoughts• Drawing or using an item in the play room

2. Together come up with “boss back words” (positive cognition)• “I can handle it”• “My best is good enough”• “I’m safe right now”

3. Have a playful battle to take action against the Worry Bully• Pool noodles/ foam swords• Ripping the paper• Scribbling

4. Modulate and repeat

• Inspired by Paris Goodyear-Brown’s Worry Wars (2010)

Play Therapy books

Evidence-based Practice Statement

Source: Association for Play Therapy (2016)

Taking the next steps in Play Therapy‣ Association for Play Therapy (APT) www.a4pt.org

• Trainings, e-learning, credentialing and publications‣ New York Association for Play Therapy

Next state-wide conference in Buffalo, April 3-4, 2020Albany, NY in spring 2021

‣ Become a Registered Play Therapist• Continuing education and supervised practice

‣ More toys?!?

Ann Beckley-ForestEmail: ann.beckleyforest@gmail.comwww.annbeckleyforest.com

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