Play Therapy

Play therapy refers to a range of methods of capitalising on children's natural urge to explore and harnessing it to meet and respond to the developmental and later also their mental health needs. It is also used for forensic or psychological assessment purposes where the individual is too young or too traumatised to give a verbal account of adverse, abusive or potentially criminal circumstances in their life.

Play therapy is extensively acknowledged by specialists as an effective intervention in complementing children's personal and inter-personal development. Play and play therapy are generally employed with children aged six months through late adolescence and young adulthood. They provide a contained way for them to express their experiences and feelings through an imaginative self-expressive process in the context of a trusted relationship with the care giver or therapist. As children's and young people's experiences and knowledge are typically communicated through play, it is an essential vehicle for personality and social development.

In recent years, play therapists in the western hemisphere, as a body of health professionals, are usually members or affiliates of professional training institutions and tend to be subject to codes of ethical practice.

Play as therapy

According to Jean Piaget, "play provides the child with the live, dynamic, individual language indispensable for the expression of he child’ssubjective feelings for which collective language alone is inadequate."
Play helps a child develop a sense of true self and a mastery over her/his innate abilities resulting in a sense of worth and aptitude. During play, children are driven to meet the essential need of exploring and affecting their environment. Play also contributes in the advancement of creative thinking. Play likewise provides a way for children to release strong emotions. During play, children may play out challenging life experiences by re-engineering them, thereby discharging emotional states, with the potential of integrating every experience back into stability and gaining a greater sense of mastery.

General

Play therapy is a form of psychotherapy which uses play as the main mode of communication especially with children, and people whose speech capacity may be compromised, to determine and overcome psychosocial challenges. It is aimed at helping patients towards better growth and development, social integration, decreased aggression, emotional modulation, social skill development, empathy, and trauma resolution. Play therapy also assists with sensorimotor development and coping skills.

Diagnostic tool

Play therapy can also be used as a tool for diagnosis. A play therapist observes a client playing with toys ( play-houses, soft toys, dolls, etc.) to determine the cause of the disturbed behaviour. The objects and patterns of play, as well as the willingness to interact with the therapist, can be used to understand the underlying rationale for behaviour both inside and outside of therapy session. Caution, however, should be taken when using play therapy for assessment and/or diagnostic purposes.

According to the psychodynamic view, people (especially children) will engage in play behaviour to work through their interior anxieties. According to this viewpoint, play therapy can be used as a self-regulating mechanism, as long as children are allowed time for "free play" or "unstructured play." However, some forms of therapy depart from non-directiveness in fantasy play, and introduce varying amounts of direction, during the therapy session.

An example of a more directive approach to play therapy, for example, can entail the use of a type of desensitisation or relearning therapy, to change troubling behaviours, either systematically or through a less structured approach. The hope is that through the language of symbolic play, such desensitisation may take place, as a natural part of the therapeutic experience, and lead to positive treatment outcomes.

Origins

Children's play has been recorded in artefacts at least since antiquity. In eighteenth-century Europe, Rousseau (1712–1778) wrote, in his book ''Emile'', about the importance of observing play as a way to learn about and understand children.

From education to therapeutics

During the 19th century, European educationalists began to address play as an integral part of childhood education. They include Friedrich Fröbel, Rudolf Steiner, Maria Montessori, L. S. Vygotsky, Margaret Lowenfeld, and Hans Zulliger.

Hermine Hug-Hellmuth formalised play as therapy by providing children with toys to express themselves and observed play to analyse the child. In 1919, Melanie Klein began to use play as a means of analyzing children under the age of six. She believed that child's play was essentially the same as free association used with adults, and that as such, it was provide access to the child's unconscious. Anna Freud (1946, 1965) used play as a means to facilitate an attachment to the therapist and supposedly gain access to the child's psyche.

Arguably, the first documented case, describing a proto-therapeutic use of play, was in 1909 when Sigmund Freud published his work with "Little Hans", a five-year-old child suffering from a horse phobia. Freud saw him once briefly and recommended his father take note of Hans' play to provide observations which might assist the child. The case of "Little Hans" was the first case where a child's difficulty was adduced to emotional factors.

Models

Play therapy can be divided into two basic types: non-directive and directive. Non-directive play therapy is a non-intrusive method in which children are encouraged to play in the expectation that this will alleviate their problems as perceived by their care-givers and other adults. It is often classified as a psychodynamic therapy. In contrast, directed play therapy is a method that includes more structure and guidance by the therapist as children work through emotional and behavioural difficulties through play. It often contains a behavioural component and the process includes more prompting by the therapist. Both types of play therapy have received at least some empirical support. On average, play therapy treatment groups, when compared to control groups, improve by .8 standard deviations.

Jessie Taft (1933), (Otto Rank's American translator), and Frederick H. Allen (1934) developed an approach they entitled relationship therapy. The primary emphasis is placed on the emotional relationship between the therapist and the child. The focus is placed on the child's freedom and strength to choose.

Virginia Axline, a child therapist from the 1950s applied Carl Rogers' work to children. Rogers had explored the work of the therapist relationship and developed non-directive therapy, later called Client-Centred Therapy. Axline summarized her concept of play therapy in her article, 'Entering the child's world via play experiences' and 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" (Progressive Education, 27, p. 68). Axline also wrote Dibs in Search of Self, which describes a series of play therapy sessions over a period of a year.

Nondirective play therapy

Non-directive play therapy, may encompass child psychotherapy and unstructured play therapy. It is guided by the notion that if given the chance to speak and play freely in appropriate therapeutic conditions, troubled children and young people will be helped towards resolving their difficulties. Non-directive play therapy is generally regarded as mainly non-intrusive. The hallmark of non-directive play therapy is that it has minimal constraints apart from the frame and thus can be used at any age. These approaches to therapy may originate from Margaret Lowenfeld, Anna Freud, Donald Winnicott, Michael Fordham, Dora Kalff, all of them child specialists or even from the adult therapist, Carl Rogers' non-directive psychotherapy and in his characterisation of "the optimal therapeutic conditions". Virginia Axline adapted Carl Rogers's theories to child therapy in 1946 and is widely considered the founder of this therapy.Kendrick, P., Wilson, K., & Ryan, V. (1992) Play Therapy: A Nondirective Approach for Children and Adolescents. North Yorkshire, UK: Elsevier Science Limited. Different techniques have since been established that fall under the realm of non-directive play therapy, including traditional sandplay therapy, play therapy using provided toys and Winnicott's ''Squiggle'' and ''Spatula'' games. Each of these forms is covered briefly below.

Using toys in non-directive play therapy with children is a method used by child psychotherapists and play therapists. These approaches are derived from the way toys were used in Anna Freud's theoretical orientation. The idea behind this method is that children will be better able to express their feelings toward themselves and their environment through play with toys than through verbalisation of their feelings. Through this experience children may be able to achieve catharsis, gain more stability and enjoyment in their emotions, and test their own reality. Popular toys used during therapy are animals, dolls, hand puppets, soft toys, crayons, and cars. Therapists have deemed such objects as more likely to open imaginative play or creative associations, both of which are important in expression.

Sandplay

Jungian analytical method of psychotherapy using a tray of sand and miniature, symbolic figures is attributed to Dr. Margaret Lowenfeld, a paediatrician interested in child psychology who pioneered her "World Technique" in 1929, drawn from the writer H. G. Wells

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