KAWA MODEL CASE STUDY NON DIRECTIVE PLAY THERAPY Aileen Duff

Queen Margaret University

08004355

AIMS AND OUTLINE OF PRESENTATION

Application of a Case study using the Kawa Model

Non Directive Play Therapy

Show how Therapy can be evaluated

Evidence Based Practice and Play Therapy

THE MEANING OF PLAY “Play is a transaction between a child and the environment that is intrinsically motivated, internally controlled and free of many of the constraints of objective reality”

(Bundy,1991)

Play is spontaneous, enjoyable, voluntary and non goal directed.

An essential element in childhood – fundamental in growth and development.

Through play children learn about the world and their relationships

Enables children to express aggression and buried feelings

(West, 1992)

PLAY THERAPY DEFINITION

Play Therapy is a relationship between the child and the therapist in the setting of the playroom, where the child is encouraged to express himself freely, to release pent up emotions and to work through his fear and anger so that he comes to be himself and functions in terms of his real potential and abilities.

A form of therapy for children where the therapist leaves responsibility and direction to the child. This approach emphasizes empowering the client, self-awareness, decision-making, and acceptance of the client's self.

Play Therapy Non Directive Play Therapy

Axline, (1986)

KAWA MODEL IN PLAY THERAPY Water - Child’s Life Flow

River Sides and Bottom , represent the child’s life environment – physical and social context

Rocks - circumstances that might be disrupting the child’s life flow

Driftwood - personal attributes and resources

(Lim & Iwama,2006)

MEET BEN

Born 2005 – 6 yrs old Volatile Early Parenting

Relationships Many House Moves Traumatic bereavement Started school 2010 - Difficult

behaviours School participation limited –

impact on friendships Sociable Enthusiastic Child, with a

good ability to play Grandmother has custody of three

siblings – impact on roles

Ben Occupational Profile

Many House Moves

Traumatic bereavement

Born 2005 – 6 Yrs Old

Difficult Early Parenting Relationships

Started school 2010 - Difficult behaviours- Now only attending for limited time .

CONCEPTUALISATION OF BEN’S RIVER

Family –grandparents& siblings

School

Play Therapy

Extended Family

Impact on ability to make friendships

Tragic Bereavement

Separation anxiety – limited

participation at school

Enthusiasm Conversational Behaviours

Sociable

Ability to Play

NON DIRECTIVE PLAY THERAPY Uses play rather than verbal exchange as principal means of

communication

Based on Carl Rodgers Client- Centred Therapy

Importance of the Therapeutic Relationship

Allows children to work through and encourage alternative ways of managing anxiety and emotions

Allows children to bridge the gap between experience and understanding

(Axline,1969; Landreth,2002)

RATIONALE FOR REFERRAL TO PLAY THERAPY

Used to treat children’s emotional and behavioural problems

Children lack capacity for abstract thought and express themselves through play and activity

Regain control, decrease anxiety and aggression

As the child guides the sessions, it is responsive to their unique and varied developmental needs.

(Landreth,2002; Miller & Boe 1990; West,1992)

GOALS OF PLAY THERAPY To provide a trusting relationship and a safe space’ for Ben

to discover his strengths and begin deal with l emotional issues

To enable Ben to experience a feeling of control To enable Ben to develop a positive self concept To enable Ben to experience some understanding of his

emotions and behaviours

In time, -to allow Ben to function comfortably within his external

environment ( particularly school)-To maximise the opportunity for Ben to pursue developmental

milestones. Landreth(2002)

INTERVENTION - PLAY ACTIVITIES

Emotional relaxation

Expression – opens communication

Safe containment

Creative medium

Sensory/tactile – compensates for lost early play ?

Actively engaged in creating a story

Plays out themes

Facilitated two way engagement

Connecting to experiences

Uniqueness of own

personality

West,1992; Lu et al(2010); Ryan and Wilson (2000)

EVALUATION OF THE PROCESS OF THERAPY

Therapy Evaluation

Objective Measures

Child Reports

Parent, Therapist or

Teacher Reports

(Naylor,2005;Dods, 1987)

EVALUATION THE PROCESS OF THERAPY Initial issue that brought Ben therapy

Within Play If maladjusted or regressive play develops -More Balanced PlayLess focussed, more emotionally appropriate

Child Therapist Relationship Improved through engagement in activityGreater connection with outside world

BehavioursAggression, Anger, Regression, ImpulsivenessMore appropriate in a variety of settings

Internally within the childImproved self esteem, confidence, appropriate maturity and

attachment (Naylor,2005)

EVALUATION OF BEN’S THERAPY

•Happier at home; getting on well with family

•Friends and coping with school

Ben

•Improvement in home behaviours

•Not necessary to stay at school

•More supported/able to return to roles

Gran

•Less separation anxiety

•Fewer behaviours in classroom

•Member of school community

School

EVIDENCE BASED PRACTICE IN PLAY THERAPYo A Challenge for research ?

(Carrol, 2000)

o Positive Outcomes Across Many Modalities (94 studies)Ray et al (2001); Wilson & Ryan (2001)

Parent’s Views Reductions in Parent-Child StressObserved improvements in behaviours

Brattan et al(2005)

Ray(2008)

o Children’s Views o The importance of the Therapeutic Relationship

Carrol, J (2000)

Jaeger and Ryan (2007)

WIDER POLICY

Developmental approach Develop more positive self

concept Building upon strengths ;

support family solutions Experience a feeling of control Self accepting Trusting of themselves and

others Learning – in a positive

environment

Getting it Right for Every Child Objectives of Play Therapy

Changing Practice Contexts : Reduced funding / EBP/

Mergers /Changing Cultural Contexts of Play

REFLECTIONS USING KAWA Holistic non-mechanistic approach

Occupation Focussed Interventions

Setting – Captures the complexities of contextual factors

Clinical Reasoning

Longitudinal aspect and Cross Sectional Aspect

Benefits of play therapy

“SPRINGBOARD TO BOUNCE INTO THE FUTURE” (WEST,1992)

REFERENCES I Axline (1986) Dibs – In Search of Self . New York. Ballantine

Books. Blunden, P. (2001). The therapeutic use of play. In: L.Lougher

(Ed.), Occupational therapy for child and adolescent mental health (pp. 67–86). Edinburgh: Churchill Livingstone.

Bratton, S., Ray, D., Rhine, T., & Jones, L. (2005). The efficacy of play therapy with children: A Meta-analytic review of the outcome research. Professional Psychology: Research and Practice, 36(4), 376-390.

Carroll, J. (2002). Play therapy: The children’s views. Child & Family Social Work, 7, 177-188.

Dodds(1987) A Child Psychology Primer – suggestions for the Beginning Therapist. New York. Human Sciences Press Incorporated.

REFERENCES II Finlay, L.(2004) The Practice of Psychosocial Occupational Therapy.

3rd ed. Cheltenham. Nelson Thornes. Galligan, A. (2000)The Place Where We Live : The Discovery of Self

through the Creative Play Experience. Journal of Child and Adolescent Psychiatric Nursing. 13(4) 169-176.

Hammond. D.,(2010) If We Don't Let Our Children Play, Who Will Be the Next Steve Jobs? Online [http://www.huffingtonpost.com/darell-hammond/if-we-dont-let-our-children_b_1017485.html

Humphry, R. (2002).Young children’s occupations: Explicating the dynamics of developmental processes. American Journal of Occupational Therapy, 56,171–179.

Jaeger, J and Ryan, V (2007) Evaluating clinical practice: using play-based techniques to elicit children’s views. Clinical Child Psychology and Psychiatry, 12(3), 437-450.

REFERENCES III Landreth(2002) Play Therapy :The Art of the Relationship. UK.

Brunner-Routledge. Lim, H. & Iwama, M.K. 2006. Emerging models- An Asian

perspective: The Kawa (River) Model. In Duncan, E.A.S. (ed). 2006. Foundations for practice in occupational Therapy. 4th Edition. Elsevier Limited: London.

Miller, C., & Boe, J. (1990). Tears into diamonds: Transformation of child psychic trauma through sandplay and storytelling. The Arts in Psychotherapy, 17, 247-257.

Naylor, A (2005) When a Child Plays - Analysing Change in Non-Directive Play Therapy. Counselling and Psychotherapy Journal. 16(5) 29-31.

Ray, D., Bratton, S., Rhine, T., Jones, L., (2001) The effectiveness of play therapy: Responding to the critics. International Journal of Play Therapy, 10(1), 85-108.

REFERENCE IV Rigby,P, Rodger,S (2006) Developing as a Player. In :Rodger S,Zivaini j

(eds) Occupational Therapy with Children:understanding children’s occupations and enabling participation. Oxford. Blackwell.

Rodger, S.(2010) Occupation Centred Practice with Children. A Practical guide for Occupational Therapists. Queensland. Wiley Blackhall.

Ryan V., Wilson, K. (2000) Case studies in nondirective play therapy. London. Jessica Kingsley Publishers.

Scaletti, R. &Hocking C. (2010) Healing through story telling: An integrated approach for children experiencing grief and loss. New Zealand Journal of Occupational Therapy,52(2),66-71

West, J. (1992) Child-Centred Play Therapy. London. Arnold Publishers.

Wilcock, A.(2006) An Occupational Perspective of Health. New Jersey. Slack Incorporated