Assessment 2 - HSO710
Transcription
The podcast discusses play therapy and the different models used in practice. It explains the therapeutic powers of play and how they are applied in each model. The humanistic model, also known as child-centered play therapy, focuses on creating a safe and accepting environment for the child to express themselves. Filial therapy involves training parents to use therapeutic skills with their own children. The learn to play model helps children develop play skills, language, and social competence. The therapeutic powers of play include self-expression, accessing the unconscious, self-esteem, accelerated development, empathy, and stress management. These powers are used to facilitate communication, increase personal strength, enhance social relationships, and foster emotional wellness. The podcast also discusses the limitations and contraindications of each model. Welcome to this week's podcast, and today I'll be talking about play therapy and reviewing the different models of play therapy that are currently in practice, and discussing in detail the therapeutic powers of play that underpin each model. And as parents and caregivers of children, my hope is that you walk away with a deeper understanding of play therapy, the different models, and its place in the therapeutic world. Today I will draw upon much of the literature found in Gary Schaefer's Foundations of Play Therapy book. I'll also draw upon Virginia Axelheim's book, Dibs in Search of Self, which is a great read for any parent wanting to find out what the sessions of play therapy are like. Play therapy has an extensive history that dates back to Freud and the early stages of psychoanalytical theory. Over the years it's continued to grow and develop, giving clinicians and therapists a unique and powerful way to help children deal with emotional and behavioural issues. Child play therapy is an approach that integrates play into counselling and therapeutic activities. In a safe and supportive way, in a play therapy room, a child is able to play out concerns, issues, frustrations and feelings that might otherwise be too difficult to talk about. As Dr Gary Landwith describes, in the play therapy room, toys become the child's words and play their language which they use to communicate. The first model we'll look at is the humanistic model, which is also known as the non-directive model or child-centred play therapy model. Humanistic models of play therapy originally established in the 1950s by psychologist Carl Rogers. Rogers developed a method known as client-centred therapy. Rather than focusing on behavioural and emotional symptoms, this model was grounded on the idea that in the right environment, every human being has within them the tendency to move towards growth, development and fulfilling their own potential. This model was later adapted by Virginia Axelene, a student at Rogers, and she also believes that children have within them the ability to self-heal and so she applied the non-directive techniques to play therapy. She presented what is known as child-centred play therapy. Axelene stated that in play, children are better able to express their thoughts, feelings and wishes and they're able to make meaning of their experiences to self-heal and to solve their own problems. In this model, the therapist is pivotal in creating an atmosphere in which the child feels accepted, non-defensive and comfortable to express themselves. These optimal therapeutic conditions encourage the child to open up and explore ideas and make meaning of their thoughts and feelings. Axelene hugely impacted the play therapy landscape, writing many books and pioneering the use of play therapy for children. In a child-centred play therapy session, the child leads the play without direction from the therapist. The child enters the room and can explore and play with whatever toys and equipment they choose. The room is set up with particular toys to encourage creative play. The child leads and directs the play that takes place and the therapist is there to be part of the journey of watching and utilising explicit therapeutic skills such as tracking and empathic responding. This therapeutic relationship is a key element of the model. The therapist's attitude towards the child always showing empathy and unconditional positive regard. Axelene created eight guiding principles that emphasise the importance of the relationship between the therapist and client. These are, number one, develop a warm, friendly relationship with the child. Two, accept the child exactly as they are. Three, facilitate an atmosphere of permissiveness so that the child is free to express self, to recognise and reflect the child's feelings in order to help him gain insight into his behaviour. Five, honour the child's inherent capacity to solve his own problems. Six, allow the child to direct the therapy. Seven, understand that therapy is a gradual process and should not be hurried. Eight, establish only those limits necessary to ground the child in the world of reality and make him aware of his responsibility in the therapeutic relationship. Child-centred play therapy focuses on facilitating the environment of safety, acceptance and trust with the person of the child as the primary focus. According to Lin and Bratton, 2015, child-centred play therapy would be useful for children who are experiencing a number of emotional and behavioural challenges. It has been found to be effective across a wide range of mental health and behavioural problems, including recovery from trauma and other clinical concerns. Other recent studies by Shen, 2002, found play therapy to be effective in helping children with anxiety and depression. And research conducted by the Griffith University found that child-centred play therapy was useful for children with autism. It found that CCPT supported improvement in communication, social interaction, mode of functioning and leisure. It also helped reduce levels of anxiety. Child-centred play therapy has also been seen to be effective with children exhibiting symptoms of ADHD and also to be effective with children with highly disruptive behaviour. Child-centred play therapy is a model that encourages autonomy and expression of thought. It's an environment free from judgement and control and it is supportive of the child's choices and helps to build confidence in the choices made. Child-centred play therapy may not be the right model to use when working with children who do not have the cognitive skills and emotional capacity to heal and master traumatic experiences. At times, children who have experienced extremely distressing events may need direction in therapy to be able to deal with the underlying issues. For example, a child who's been sexually abused may play and act out behaviour that is sexually inappropriate and they need direct intervention from a therapist. It may also not be suitable for children who are unable to engage in or initiate play. This can happen for various reasons. It may be trauma and a child is unable to access the freedom to engage in self-initiated play. Or perhaps they lack the developmental skills to engage in self-directed play. Next we will look at a systemic model. A systemic approach to child play therapy is when we consider the child in the context of the current systems that they are a part of and incorporate these systems into the therapeutic approach. One systemic model is filial therapy. Filial therapy is a type of play therapy that involves training parents and caregivers to use therapeutic skills with their own children. It was first established in 1964 by Bernard Gurney as a relationship enhancing child family therapy. Recognising the child in the system of family can help target the child's needs within that environment. Bernard's wife, Louise Gurney, later joined his work and together they worked on the methodology for filial therapy and advocated for its implementation and practice within play therapy. Here is Louise giving a brief description of filial therapy. The way it works in filial is that parents play using a child-centric play therapy with their children. They are trained and supervised by professionals. So it has the effect of making the parent the primary therapist and at the same time making the regular therapist, the professional therapist, a trainer and supervisor of the parent. In filial therapy, the therapist involves parents as the main change agents for their own families and this is done by training and supervising parents to do non-directed play sessions with their own child. As parents become more confident with their child-centered play therapy model, the play sessions can move to their home environment where a therapist will continue to monitor the process and the hope is that the skills learnt will be transferred and utilised into the daily family life. The Gurneys believe that many parents simply lack the parenting skills or knowledge to be able to assist their children, steering away from popular thought at the time that it was parents that were the source of their child's problems. Filial therapy differs from traditional clinical practices of therapy in that it emphasises the positive and constructive by focusing parents' attention on what can be learned and practised rather than on the negative or dysfunctional. According to research by Gurney and Ryan, the types of children and families that could benefit from filial therapy would be those who are experiencing difficult child-parent relationships, or those children showing issues of attachment. It would also be good for children with depression and anxiety, children with mild autism spectrum disorder, children who have experienced chronic or terminal illness and children who have experienced traumatic events. Contraindications for children using filial therapy have also been outlined by Gurney and Ryan who suggested the model would not be suitable for severe levels of unaddressed mental health issues, psychosis, profound autism or high levels of aggression or very serious attachment disorders. The next model we'll look at is the emerging Learn to Play model. Learn to Play is an intervention play therapy model that works on building a child's play skills, their language, social competence and flexibility. It was developed by Karen Stagnetti in 1998 when she was working with children and she saw that some of them did not know how to play. Learn to Play has its roots in the theories of Axelheim and her non-directive approach and in Vygotsky theory and in his belief in the sociocultural dimensions to play and cognition and his theory of zone of proximal development. Vygotsky suggested that in play children use toys and objects to form and manipulate concepts and symbols. Through her work Stagnetti discovered that many children lack this ability to engage in pretend play or they did not have the pretend play ability expected for their age. So she developed the Learn to Play program to assist children to develop the ability to spontaneously self-initiate their own play and to develop age-appropriate pretend play skills to become better and active players with their peers. Unlike child-centred play therapy and other non-directive play models, Learn to Play is a controlled approach to play therapy. The program begins with clear direction from the therapist and as the child's play skills develop the therapist takes a less directive approach as the child begins to spontaneously self-initiate their own play. Throughout this the therapist stays attuned to the child's needs and directs and guides when necessary. The therapist has a clear understanding of the child's development in play which is gained through various assessment and play activities. So there are explicit goals of play set and they are worked towards by the child and the therapist in each session. There is clear intention and direction in the Learn to Play model. The therapy focuses on developing particular skills within the child relating to play and self-directed play. Particular toys and objects are chosen by the therapist in order to achieve the goals they are working towards. The Learn to Play model would be beneficial for any child who finds playing with toys or objects difficult or they need help to be able to play with friends. This could include children who suffer from anxiety or low self-esteem. It has also been shown to be beneficial with children who have ADHD or Autism Spectrum Disorder and also for children who have suffered brain injuries. The model has been shown to clinically improve children's language skills, social understandings, the initiation of play, better thinking strategies, all leading to increased time in self-initiated independent play. This model was not designed for children over the age of 11 so may not be as effective when using with older children or teenagers. This model has its limitations with children who have suffered extremely traumatic events or abuse or suffering from PTSD. The controlled directive environment with clear goal setting does not lend itself to exploring the inner workings of a child, their subconscious and working through the traumatic experiences they have endured. Essential to all of these models are the therapeutic powers of play. In the playroom setting, the therapist must employ particular skills, qualities and behaviours that act as change mechanisms within the play sessions. Schaefer in 1999 first described these as the therapeutic powers of play. These powers of play are the instruments in play that actually produce the desired change in a child's psychological and emotional wellbeing. These therapeutic powers of play have been known to be the heart and soul of play therapy. They guide a therapist so that they are able to identify the needs of the client and apply the specific powers of play necessary to reach the desired change. The sound knowledge of these powers of play is foundational to understanding how and why play fosters therapeutic change. Regardless of the approach or model used, these powers of play are the hallmark of a successful therapist. The therapeutic powers of play have been divided into four overarching domains, with each containing specific powers of play relevant to the domain. There are 20 in total. The four domains are facilitates communication with powers of allowing self-expression, access to the unconscious, indirect and direct teaching. The next domain increases personal strength, which is the power of self-regulation, creative problem solving, resiliency, accelerated psychological development, moral development and self-esteem. The third domain enhances social relationships, which includes encouraging social competence, empathy, attachment and therapeutic relationship. The last domain is fosters emotional wellness, which includes catharsis, counter-conditioning fear, abreaction, positive emotions, stress inoculation and stress management. For the sake of this podcast, I will now draw upon Axelene's book, Deepened Search of Self, and her noted use of child-centred play therapy to highlight the therapeutic powers of play during her sessions with him. The therapeutic powers of play will be discussed as TPOPs. Under the domain of facilitating communication, we can see the TPOPs self-expression at play. Axelene's client, Gibbs, initially presents as having developmental limitations with his language and communication skills, and during his initial sessions he presents as guarded and withdrawn. He makes statements and his communication is limited. Over time, through his self-directed play, we see Gibbs communicating more clearly, sharing conscious thoughts and feelings with the use of figurines and toys he plays with. Through symbolic representation, he begins to express and communicate his home life situation and the frustrations he has with being misunderstood. During the same symbolic play, we see Gibbs engaging with the TPOP, accessing the unconscious. He shows a fascination with doors and locks while playing with the miniature toys and houses. Axelene, showing no judgement or concern, simply tracks his play with empathy, reflecting feeling. Gibbs, feeling comfortable, reveals an inner conflict at play, obsessing with all the doors and how they must be locked. He is projecting an internal conflict into his play story, allowing the therapist insight into his inner working world. Under the domain of increased personal strength, we see this therapeutic power of self-esteem and accelerated development occurring with Gibbs. He comes to the playroom as a timid boy, reluctant to speak and share his stories. But as time goes by, Gibbs experiences complete acceptance and permission to be himself, without fear of judgement or pressure to change. No matter his choice of play words or actions, he is accepted and given the freedom to explore his desires. In this place, we see his self-esteem growing, as Gibbs begins to gain confidence in himself and in his thoughts. This confidence begins to translate into his home and school life, as he engages more confidently with others in his world. We also see the TPOP of accelerated development. When Gibbs first begins play, his therapy sessions, his teachers and parents all believe he has significant developmental delay, both emotionally and incognitively. But by the end of this year of weekly play therapy sessions with Axelene, Gibbs has not only accelerated in his emotional and cognitive development, but has found to be extremely gifted and articulate, scoring a high Q for his age. Under the domain of enhanced social relationships, we see strong mechanisms of empathy and therapeutic relationship. Over time, Gibbs and Axelene share a unique bond in their client-therapist relationship. Axelene creates an environment built on empathy, trust, understanding and unconditional positive regard, and in doing so, establishes a strong connection with Gibbs. They form an attachment bond of safety and trust, and in turn, this connection and secure base gives Gibbs the security to explore his world and thoughts. This secure attachment creates within Gibbs a sense of self and positively influences his other primary relationships. Gibbs, having experienced empathy from Axelene, begins to engage in showing empathy for others. The relationship with his parents becomes less fractured, and his engagement with his peers is far more adapted. Under the domain of fostered emotional wellness, we can see the TPOP of abraction and stress management. In a moment of abraction, we see Gibbs reliving a stressful and traumatic moment. Through play, he re-enacts a scene from a party, setting up cups and pretend food, and spilling the cups and making a mess. He causes the party to come to an abrupt end, crying, Stop! Gibbs is distressed and leaves the playroom. Axelene tracks his behaviour and follows Gibbs out. She allows him to process the memory, not interrupting, but allowing Gibbs to feel the emotion and to implement self-stress management skills. Gibbs successfully gets through the relived storm of emotions and finds within him the strength to cope with his hurt feelings. These powers of play at work are the instruments that ultimately produce the desired change in a child's psychological and emotional wellbeing. I hope that this podcast has given you a brief introduction into play therapy, the models at work, and the therapeutic powers of play that underpin each of the models.
