COURSE OBJECTIVES:
COURSE OBJECTIVES
Play a Group Game
Part One
History, Models, and Beginning
A Short History of Work with Children
Child Guidance Movement – 40’s and 50’s
Hospitalization
Community Mental Health – 60’s and 70’s
Schools seen as primary prevention and assessment sources – 80’s –
Youth Service bureau movement
Family Systems Movement
Psychiatry and Managed Care – Era of mental health as big business.
A Short History of Models of Play Therapy
Little Hans - Freud's work with a phobia
Virginia Axline (1947) -  Play Therapy
Bernard G. Guerney, Jr. (1964). Filial therapy
Clark Moustakes, (1973). Children in Play Therapy - relationship based
 D.W. Winnicott, (1977). The Piggle: The psychoanalytic treatment of a little girl.
A.M. Jernberg, (1979). Theraplay
.Schaefer, C.E. & O'Connor, K. J. (Eds), 1983).  Handbook of Play Therapy
Combrinck-Graham, L. (1989) (ed). Children in Family Context
O'Connor, K. J. (1991). The Play Therapy Primer
McMahon, L. (1992). The Handbook of Play Therapy
Landreth, Gary (   )

Play therapy is
Symbolic
The world of the child
Acts out real life conflicts and issues
Fun
Play therapy is just that -- it is not a talking therapy, but it can lead to that.

Typical Goals of Therapy
Enhance child’s self control, self-concept, and self-efficacy.
Help child become aware of his or her feelings.
Have a place where child can feel safe in exploration of self.
Learn and practice self-control and alternative behaviors.
Develop capacity to trust adults.
Develop capacity to relate to an adult in an open, positive and caring manner.
Frameworks
Psychoanalytic
Relational
Jungian
Adlerian
Gestalt
Family Systems
Client Centered - Child Centered
Frameworks
Cognitive - Behavioral
Solution Focused
Narrative
Strength-Based
Theraplay
Children who are appropriate for Play Therapy
Children who are appropriate for Play Therapy
Equipment
Puppets
Art
Sand Play
Games
Doll Houses
Almost any toys
Paper and Crayons
Cars and Trucks
Toy guns and knives
Costumes, dress-up
Play Doh
Water play
Games, i.e, cards, checkers, etc.
Equipment
Sock Puppets
Art  - House Tree Person, Family
Play Mobile Dolls
Play Therapy Space
12 by 15 foot room
Sand Table
Sink
Privacy
Doll House
Secure shelves for holding favorite objects
Counter Top space, with table and chairs

Research
Only efficacy studies show positive outcome
Filial Therapy has higher evidence of positive outcome than individual play therapy, and;
Family Treatment of children's problems have a greater positive outcome with certain problems
Research
Association for Play Therapy and their Research studies.
http://www.iapt.org/index.html
Research
Only efficacy studies show positive outcome
Filial Therapy has higher evidence of positive outcome than individual play therapy, and;
Family Treatment of children's problems have a greater positive outcome with certain problems
Reasons for Play therapy
Used when there is an individual vs. systemic orientation towards psychotherapy and counseling.
When there is limited contact with family members, i.e., when child is in foster care, residential treatment, victim of abusive, or when parents are otherwise unavailable to treatment.
When funding source insists on this form of therapy as a preferred mode of treatment.
Four different models
Virginia Axlin, (1947).
Clark Moustakes, (1973). Children in Play Therapy - relationship based
Bernard G. Guerney, Jr. (1964). Filial therapy
Family Play Therapy
Model One
Child-Centered Play Therapy
Virginia Axline
Virginia Axlin Child-Centered Play Therapy
Major Premises of Theory
Comes from Rogerian model.
Called child-centered play therapy.
Is Non-directive
Reflects feelings, restates content, and returning responsibility to the child.
Believes that children are able to work out their problems through use of unconditional positive regard.
Major Premises of Theory
It is: “a philosophy resulting in attitudes and behaviors for living one’s life in relationship with children.  It is both a basic philosophy of the innate human capacity of the child to strive toward growth and maturity and an attitude of deep and abiding belief in the child’s ability to be constructively self-directing. (Landreth and Sweeney, 1997)
The seminal work on play therapy with children was written by Virginia Axlin in 1947. She outlined eight principles of working with children in therapeutic relationship that makes good sense even today. They are:
1.  The therapist must develop a warm, friendly relationship with the child, in which good rapport is established as soon as possible.
2. The therapist accepts the child exactly as he/she is.
3.  The therapist establishes a feeling of permissiveness in the relationship so that the child feels free to express his/he feelings completely.
4.  The therapist is alert to recognize the feelings the child is expressing and reflects those feeling back to him/her  in such a manner that the child gains insight into his/her behavior
 

5.  The therapist maintains a deep respect for the child's ability to solve his own problems if given an opportunity to do so, The responsibility to make choices and to institute  change is the child's.
6.  The therapist does not attempt to direct the child's actions or conversations in any manner.  The child leans the way; the therapist follows.
7. The therapist does not attempt to hurry the therapy along.  It is a gradual process and is recognized as such by the therapist.
 

8. The therapist establishes only those limitations that are necessary to anchor the therapy to the world of reality and to make the child aware of her responsibility in the relationship.
(Axline, 1947, pp. 73-74).
Five Phases of Child-Centered Play Therapy
1. Child uses play to express diffuse negative feels.
2. Uses play do express ambivalent feelings, i.e., anxiety, or hostility.
3. Express mostly negative feelings, again, but the target is now more specific, i.e, parents, sibs, or therapist
4. Ambivalent feelings resurface again but the target is now  more specific, as in #3
5. Positive feelings are now predominant, but negative feelings are more grounded and realistic.
Model Two
Relationship Playtherapy
Clark Moustakas
Relationship Play Therapy
Major Premises of Theory
Therapy happens within the context of the therapeutic relationship.
The therapist sets limits that “do not tamper with the will of the child.”
Therapist enacts personal limits.
Therapist uses him or her “self”  in therapy.
Response to aggressive behavior.
Children have within themselves the ability to control their behavior, and want to.
Video Clip
Assignment for Next Week
Find access to a child;
Design a first session, including equipment, model or theory you are operating from;
With the permission of the child’s parent or guardian, spend one hour with that child, practicing the fine art of play therapy;
Be prepared to discuss this work next week.
Part Two
Practice Reports, Model, and Tailor Made Session
Model Three
Filial Play Therapy
Bernard and Louise Gureney
Filial Therapy
Major Premises of Theory
Was developed by Bernard and Louise Guerney, (1964).
Combines play therapy and family therapy in a highly effective model.
Therapist trains and supervises parents as they conduct “child-centered” play sessions with their own children.
Usefulness with:
Strengthens family relationships that have been strained by illness.
Provides parents of an ill child a “proactive” way to help at a time when they might feel quite helpless.
Can provide quality time during a stressful situation.
Can restore a sense of control during these times.
Process of  Filial Play Therapy
1. Therapist explains the rational and process of filial play therapy.
2. Therapist demonstrates the play therapy session, as the parents watch and record their observations.
3. Therapist discusses the session demonstration with parents afterward.
Process of Filial Play Therapy
4. Therapist trains the parents in the four basic play therapy session skills;    structuring, empathic listening, chld- centered imaginary play, and limit  setting.
5. Mock play therapy session, with feedback from therapist, and discussion of session, including skills feedback..
Process of Filial Play Therapy
6. Parents begin play therapy sessions, under supervision of the therapist.
7. When parents begin to feel comfortable with the process, they begin the sessions at home.  Parent(s) and therapist meet to discuss and problem solve the sessions, and generalize the skills to everyday life.
VanFleet, (1994)
Model Four
Family Play Therapy

Family Play Therapy
Schatz, I.M. (1998).  Meeting Noodle Face Noah: Child Oriented Family Therapy.  Journal of Family Psychotherapy. 9(2), 1-13.
Ariel, S. (1992). Strategic family play therapy. New York: Wiley
Chasin,

Basic Premises of Family Therapy
Systems are a series of interconnected, inter-related, interdependent parts, whose whole is greater than the sum of it’s parts.
A change in one part of the system will result in effect the rest of the system.
All action is recursive, there is no real cause and effect – all behavior is defined by, and understood within the context in which it occurs.
Problems are maintained by the system.
Psychopathology is not something that resides in someone, but occurs in relationships.
Reasons for Family Play Therapy
Children are thus available to the counselor for direct observation and intervention.
The family is better understood if children are “known” through direct contact, rather than hearsay.
Children may and will have their own unique viewpoints, and contribute to sessions with their spontaneity, immediacy and candor. (Chasin, and White, 1989).
Typical Differences between Individual and Family Play Therapy

Individual Play Therapy

Distanced
Nondirective
Imaginative

Family Play
Therapy

Involved
Directed
Factual
Family Play Therapy
Family Play Therapy is more directive, as in proscribing what the child and family should do, i.e., “draw a family doing something,” or in role playing, i.e., “You’re Dad at the dinner table and your brother is Mom, who has just arrived home late form work.  Make up a skit that shows us what would happen if your parents got along exactly the way mom wants them to.”
More Reasons for Family Play Therapy
Through drawing and play, children may express more of their concerns than through mere discussions.
Families become actively engaged and display high levels of energy.
It is informative about everyday life.
There is a great enthusiasm in the way family members impersonate each other, and he honesty with which the represent everyday life.
Six Phases of a Family Play Therapy Session
1. Orientation
2. Joining
3. Goal statements
4. Goal enactments
5. Problem exploration
6. Advise
              Chasin, Roth, & Bograd, (1988)
 

Six Phases: Orientation
First part of session
Introduction of therapist, and have family members introduce themselves.
The therapist shares information that he/she has obtains previously.
State the purpose of the session “we are here to talk about “Joy’s behavior and  how it is effecting all of the family.”
Sets up the rules of therapy i.e., everyone will have an equal chance to talk; no ganging up on one person, no fighting, etc.

Six Phases:  Joining
Establishing a working alliance with the family, and all the members.
First few minutes of chit chat, to relax and get to know, or later to reacquaint and get up to speed with where the family is this week.
Set the tone for the meeting:  Not an anxiety provoking situation
Six Phases: Goal statements
Several ways of attending to this, but it is believed that by focusing on the problem at this point, a negative set may occur.
Better to ask questions that are directed toward the here and now, such as “what is it that you would all like to accomplish here today?”
This is easier said than done, as most families anxiety carries them to the “problem.”
 

Six Phases: Goal statements Continued
“Can you each tell me how your family can be even better than it is now?  Who would like to go first?”
Goals are most helpful when the are concrete.
Encourage them to turn any complaints or blaming into a future goal, or accomplishment for the future -  stress behaviors, not character assassinations.
Six Phases: Goal Enactments
Role play how those goals my look.
Directing a movie, i.e., “show us what that would be like.  How would your mother be acting towards your brother, if this was to happen.”
Michael White calls these preferred outcomes.
Again, get specific when it comes to behaviors, so that the family might “move” into them.

Six Phases: Problem exploration
1. Does a problem really exist?
2. What are the cycles or sequences that are associated with the family problem?
When and in what context does the problem exist? What are the constraints?
What has been done to solve the problem?
What are the belief systems that prevent the family from finding a solution?
Six Phases: Advise
Summary statement should include:
1. A respectful acknowledgement of the family’s strengths.
2. A Brief summary of the family’s wishes and fears.
3. One or two hypothesis that connect the problem with well-intended and wise traditions ( that are not currently working)
A clear recommendation for future action, and a rationale.  (Chasin & White, 1989)
Video Clips
Model Five
Group Play Therapy
 A Few Management Strategies for Group Play Therapy
Rules;
1. Limit rules to four to six, so they may be remembered.
2. Phrase rules in the positive (to do) rather than (don’t do).
3. Refer to specific observable behavior (Hand to yourself)
4. Positive consequences (praise and rewards) for following rules, with negative consequences (private reprimand, brief time outs) to rule violations.
 A Few Management Strategies for Group Play Therapy
Review rules at beginning of each session, with each child choosing a rule to explain.
Make rules short and to the point.
Wait your turn
Stay in your seat
Talk quietly
Hands to yourself
Raise your hand

 A Few Management Strategies for Group Play Therapy
Use social rewards, such as praise, smiles, “thank you.”
Single every child out for some praise and attention.
Become spontaneous with praises.
Send a frequent note home to children's parents when they have behaved well.
Use of one-two-three magic is useful.  Specify consequences and then follow through when there is a need.
Michael White’s Play Therapy for Encopresis
Externalize the problem.
Remember that the child is NOT the problem, the problem is the problem.
Help child discover times when they have had victory or where able to defeat the problem.
Devise strategies to overcome the externalized problem, and map them out.
Elicit the parents support in this endeavor.
The Portable Play Therapist
Suitcase or something to hold all the play equipment.
Pad of manila paper;
Big 54 box of crayons
Three or more sock puppets
Several sets of Play Mobiles – families and specific focus sets.
The Portable Play Therapist
Play Doh
Squirt Guns
Cards
Battle Ship
Rubber knife
Therapeutic books
The Ungame

Managed Care Expectations
1. Do the symptoms or complaints require treatment?
2. If so, how does one gauge outcome and effectiveness of treatment?
3. Why pay for play therapy (family play therapy) when medication or other media are seen as the current appropriate mode of treatment?
Managed Care Expectations
Why is treatment necessary?  How is it life or function threatening?
Can you demonstrate how the problem impacts on development and/or future growth cognitive and emotional and behavioral performance?
Managed Care Expectations
Demonstration of Efficacy and Outcome Effectiveness.
Well documented evaluation indicating that there are no other likely medical or psychiatric causes of the problem.
Very specific behaviors among family members are shown to be contributing to problem, thus need for treatment.
Various measures of outcome can be tracked, indicating improvement, i.e., school performance, like absenteeism, school incidents, improvement in academic performance, etc.
Web Site Resources
Association for Play Therapy
http://www.iapt.org/
Filial Therapy
http://www.play-therapy.com/
Canadian Play Therapy Association
http://www.playtherapy.org
Midwest Play Therapy Institute
http://ccpe.smsu.edu/mpti/
Transpersonal Sandplay
http://www.sandplay.net/
That’s all for now, folks !
This workshop was presented by the good folks at Oakton Community College.
Dr. Jeffrey K. Edwards, LMFT is presented through the cooperation of Northeastern Illinois University, Department of Counselor Education, Family Counseling Program. 773-442-5541
Dr. Edwards is available for workshops and clinical supervision.