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Psychotherapy.co.za : Articles : Articles : Parenting and Children : Show Entry

 Play Therapy
Submitted By DavidvdW | Added on: 2010 November 16 | Total Visits: 12984 | Printable version

How does Play Therapy work?

A guide for parents

Dr Jana Lazarus and Miranda Wannenburgh
Few parents know what the inside of a play therapy room looks like during a session – what is happening, what is the therapist doing, and, most importantly, what is your child doing?! Also, how does what happens there work therapeutically, to make your child better?

Few parents know what the inside of a play therapy room looks like during a session – what is happening, what is the therapist doing, and, most importantly, what is your child doing?! Also, how does what happens there work therapeutically, to make your child better?

Parents bring children to a psychologist for play therapy when they are concerned about the child’s behaviour – perhaps your child is “acting out”; that is, throwing tantrums, being aggressive, or resisting discipline. Or perhaps s/he is lacking in confidence, clingy, struggling to make friends, or seems down and withdrawn. A child may be anxious, afraid or having nightmares. S/he may be struggling with bedwetting and bowel control. S/he may be hoarding items, lining toys up, and be very upset by change of any sort. Alternatively, parents may be going through a divorce or a family bereavement, and may simply want help in supporting the child, and some input about how to handle the situation.

As parents we all try to deal with these scenarios as best we can, up to a point where we realise we may need a professional to help shift our child. We find that one of the most helpful things psychologists offer parents is an increased understanding of exactly what is going on with their child, and how to fix it.

In child-centred play therapy, your child will come into a room filled with specially chosen toys – simple, non-specific items like puppets, a sandbox, a doll’s house, and lots of paint, crayons and paper (no Barbies!) Younger children below the age of 10 will be told that they can play here in many ways that they themselves choose to. Older children (up to about the age of 13) will be engaged in more specific tasks by the therapist – such as a “complete the sentences” exercise, or they will be asked to draw a person, a house or a tree, and there might be more conversation.

As the young child plays, it is the therapist’s job to give sustained, non-intrusive attention to the child and his/her actions. We use words to comment on what we are seeing – the toys the child is choosing, and what s/he is doing with them. This is called tracking, and while it may sound a bit like sports commentary, no child has (yet!) told us to “shut up while I play”! It seems children thrive on the interest.

The therapist is looking for themes in the play. If something is of concern to a child, s/he will repeatedly return to that theme during the session, and across sessions. For example, an anxious child might do a lot of play or drawing involving bogeymen and other fears. In the case of divorce, a child may play out worries about separation. It is best to have at least 3 assessment sessions so that one can be clear about the really persistent, main concerns over time.

Fortunately, as children play out these concerns, they are also beginning to work through them. Concerns are symbolised in play (the play is an “as if” situation, compared to real life) and it is also in play that outcomes can be changed, stories retold, and fears vanquished. We find that the child’s autonomy in the playroom (freedom of choice) boosts his/her sense of agency (or personal power) and that the quality of the therapist’s attention boosts the child’s self-esteem. The therapist gives a lot of what children need, namely unconditional positive regard, devoted interest and mirroring (reflecting the child’s feelings). When a feeling is detected or noticed during the play, the therapist will put it into words: “That makes you feel sad”; “You are excited about it.” In this way children become more aware of what they feel, and also start learning the skills to put their own feelings into words: “I am disappointed.”

The therapist also sets boundaries in session, should the need arise: “I am not for hitting!” Some children really seek boundaries, in order to feel safe, and a lot of time can be spent showing the child what the parameters of the hour are. Often, when parents are inconsistent in their discipline at home, children present with a need to know “what’s what” more clearly.

So, by the end of a 3-session assessment session, a child will already be starting to work through his/her concerns, while the therapist will have gleaned valuable information about what is going on in the child’s inner world.

At this point, parents often report an improvement and will say with amazement, “Wow, what did you do?” Well, the fact is, not much: we simply provided the right kind of space and holding for the child to start doing his/her own exploration and healing. And children do; they are incredibly adaptable and resilient. That is why it may be a good idea to bring your child along for some play therapy, while s/he is in the “plasticity” of an early developmental phase – rather than leaving things till s/he is 30, and paying a psychoanalyst for years of talk…!

At this point we give parents feedback about what the child is anxious or angry about, or why s/he is depressed. Sometimes this is clear to parents, but with the workings of the unconscious, it may be necessary to unpack some of the convolutions: for example, a child who is afraid of losing his absent father may express some of his anger at this parent towards his mother instead. Or, a child whose home was broken into when she was little may still, many years after the incident, display signs of fear despite her parents’ repeated attempts at reassurance.

At this point we also give parents pointers about how to handle the child at home in specific situations. Often, our recommendations are unexpected and may not be the thing that a parent would necessarily have come up with naturally. This involves some commitment to trying a new habit. Parents normally come on board quite quickly when they see the strategy working and resolving the problem. We provide parents with written pointers, handouts and cartoons. While parenting comes naturally, our best intentions sometimes trip us up – for example, you may have had a brutal parent yourself, and decide never to be like that towards your own child. After a while your child may become increasingly naughty and unmanageable because it just feels too painful for you to be firm sometimes – it reminds you of your past trauma. Meanwhile, your child is losing out.

It is not always necessary for a child to commence an extended course of play therapy after the assessment period and parent feedback. Another 3 sessions or so can cement the healing and the solution, in conjunction with the parents’ new programme at home – together this forms a powerful intervention. Sometimes, particularly in cases of severe trauma or developmental disorders, it may be necessary for the child to have a longer play therapy contract (up to 15 sessions). Play therapy is covered by Medical Aid if the therapist is a psychologist registered with the HPCSA.

We wish you and your child many growthful experiences – together you can learn that obstacles are there to be overcome, and that you can handle all of life’s situations with a little timely help from your friends! Happy playing.


Dr Jana Lazarus is a Clinical Psychologist in Kalk Bay who completed a doctorate on the subject of Infant Observation. Together with her colleague Miranda Wannenburgh, she runs a psychotherapeutic practice called Change Matters.

To read more or to book an appointment for play therapy, see their website:

http://www.changematters.co.za/files/individualtherapy.html

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