by Irene Chiang

[Abstract]
Play therapy, evolved from analytic psychology and developed in the 1960’s, has been an increasingly popular psychotherapy technique in many countries of the world, especially for treating children and adolescents. The demand for play therapy is high in the United States, and it has attracted more and more people in Taiwan as well. This critique paper will begin with a brief history on the development of play therapy, its applications, and which population would generally benefit the most. Next, this paper would also discuss possible limitations of play therapy, and offer personal perspectives on the application of play therapy.

CRITIQUE ON PLAY THERAPY

Play therapy is “the systematic use of a theoretical model to establish an interpersonal process wherein trained play therapists use the therapeutic powers of play to help clients prevent or resolve psychosocial difficulties and achieve optimal growth and development” (Association for Play Therapy, Inc. Right column, 5). Play therapists based their practice on counseling theories and apply play as the medium to observe, discover, understand, and predict behaviors of their clients, mostly children.

Development of Play Therapy

In 1903, Sigmund Freud outlined the oral, anal, and genital stages as childhood instinctual development, and in 1909, he became the first person to apply psychotherapy with children (Drisko, 2005). Pioneers of psychotherapy for children, such as Anna Freud, Margaret Lowenfeld, and Melanie Klein were the first to annotate the use of play in therapy (British Association of Play Therapists, 2004). In 1919, Melanie Klein began to use play therapy techniques as her method to analyze children under 6 years of age. Anna Freud also utilized play therapy techniques, but her purpose was to encourage children to establish a relationship with her. They both agreed that play is the best way for children to express themselves freely (Landreth, 2002).

In the 1940’s, Carl Rogers established nondirective therapeutic approach, later renamed client-centered therapy, and now it was termed person-centered therapy (Landreth, 2002). This new approach was developed as a protest against the diagnostic and prescriptive perspectives of psychotherapy at that time, emphasizing a relationship between the therapist and the client based upon genuineness, acceptance and trust (British Association of Play Therapists, 2004). For children, the purpose is not to control or change them, but for them to achieve self-awareness and self-guidance. The therapist actively reflects the child’s thoughts and emotions, and believes that when the child’s emotions are expressed, understood, and accepted, the child would be able to accept her- or himself and process these emotional experiences with ease (Landreth, 2002).

Virginia M. Axline was deeply influenced by Rogers’ person-centered approach, and later developed nondirective play therapy. She utilized the person-centered theoretical foundations, and devised a clear and concise theory of play therapy and its techniques (British Association of Play Therapists, 2004). Axline considered that experiences of play could bring therapeutic effects because they provide a secured relationship between the child and the adult that the child would be able to express her- or himself in her or his own term and duration of time (Landreth, 2002). In the 1960’s, counseling and guidance centers were established in many elementary schools in the United States (Landreth, 2002), and with the formation of professional associations in several countries later on, play therapy has gradually gained its popularity.

Application

Play therapy is believed to be most beneficial for children, because play is a common and important part of children’s life, and the way they use play is like the way adults use language. According to Erik Erikson’s psychosocial stages of life, preschool children are in the stage of “initiative versus guilt”; “their energy is directed toward competence and initiative. Rather than indulge in fantasies, they learn to be involved in social and creative play activities” (Sharf, 2004). For school age children, they are in the stage of “industry versus inferiority,” and they have to learn fundamental skills necessary for school and gender-role identity during this period (Sharf, 2004). Therefore, play is crucial for children’s learning and socialization experiences. From my personal experience, I remember myself played “we are a family” with kids in our neighborhood when I was young. We took turns play different family members and pretended that we were cooking, having meals, studying, working, or playing, just like doing normal daily activities. I had obtained a good idea about my own gender role during my playtime.

Next, “play therapy is beneficial to a child who is experiencing difficulties in the home, school or community” (Canadian Association for Child and Play Therapy, 2004, 2), especially for those who have experienced crisis. This is frequently done in the form of group play therapy, and the purposes are: (1) let off the fear; (2) help children release their feelings of traumatic experiences; (3) offer parents an opportunity to take a break (Webb, 1999). When the 921 Earthquake hit central Taiwan in 1999, there were many people, including children, who lost their homes, family members, and friends. Several counseling training programs, including play therapy workshops, were established to train helping professionals and educators in order to help child victims of this disaster. In Taichung, Dr. M. K. Shih was appointed by the City Government to lead regular play therapy groups for children and established play therapy rooms in several elementary schools. While dealing with such a traumatic experience, many children were reported to have gradual progress after attending play therapy groups (Taichung City Government, 2004).

Moreover, play therapy is also helpful for children with language difficulties. In Taiwan and many other countries, it is widely used to help autistic children. Based on a survey conducted by Special Education Annual Report, the number of autistic school children has increased from 1374 to 2121 with more than 20% growth rate. Due to the lack of specific knowledge, treatment facilities, and professional therapists, Autism Society Taiwan, R. O. C. has been giving play therapy training programs for parents, teachers, social workers, and health professions for several years, and opening special courses with play therapy techniques for autistic children to help them and their families. According to a recent report, after two to three months of such a program, autistic children were reported to have huge progress. They not only did a lot of echolalia, but they were also able to actively perform verbal expression in certain situations. Furthermore, they were more capable of stabilizing their emotions and following guidance (Yang, 2006). I used to be a teacher’s volunteer for an autism foundation, so I agree with the statement that play therapy is able to help autistic children improve their abilities of expression, interaction, and socialization.

In addition to child population, play therapy could also be applied in parent-child therapy and family therapy. By joining therapy sessions with their child, parents have the opportunity to observe the interaction between the therapist and their child, and play games with their child under the therapist’s guidance and supervision. In the process, they would develop a new perspective toward their child, and become more empathic and tolerant as well. If what the therapist has done for the child is helpful, parents could then adapt it in their home environment to improve communication within their family (Landreth, 2002).

Although play therapy is still not a commonly used way to treat adults, it might also be helpful for them, because the focus of such an approach is not on the players themselves. It helps adults pay their attention to games and activities in order to obtain a feeling that cannot be delivered through language. When I took dance/movement courses in Calgary, Canada in summer 2004, our professor introduced some play activities that could be adapted into dance therapy sessions for the parent-and-child dyad or among adults. As she briefly explained and displayed props and toys in front of us, we picked them up, teamed ourselves, and actually played games. We laughed frequently, and our professor was also kind enough to allow us extra time to personally experience the games she has introduced. As I think back, I am surprised how engrossing everyone has become during that class session. Therefore, I believe that play therapy could be beneficial for adults as well.

Limitation

Although play therapy has been proved to be effective for children with various kinds of diagnoses, it is not as helpful for certain types of children, such as children with the most severe degree of autism and schizophrenia (Landreth, 2002). These two types of children live entirely in their own world that they cut off their interaction with the outside world completely. Because they lack the ability and willingness to interact with people and objects, play therapy might not be the best therapeutic approach for these children.

Next, adequate amount of space and sufficient number and types of toys, props, drawing or painting tools, and/or even sandboxes and sand are necessary for conducting play therapy. For institutions with limited space and budget, it would be a challenge for them to embrace play therapy. In addition to space itself, the material for construction and decoration inside the play therapy room is also crucial. Because of the nature of play therapy and its usual clients, paints or crayons would easily stain walls and floors; specific types of easy-to-clean material would be necessary. Again, for institutions with insufficient knowledge and limited budget, it is unlike to ask for renovations, and after-session clean up might be a headache for all.

Personal Reflection

Toys are frequently used in dance/movement therapy, and it is not unusual for dance/movement therapists to carry bags of props and toys from session to session, so I am familiar with the idea that props and toys are essential tools for creating more in-depth personal experience and more effective therapeutic result for the client. The other thing is that several play therapy techniques are easily adapted into other types of creative arts therapy and general counseling, for those techniques could serve as an icebreaker, especially for child clients, and those who have difficulty expressing themselves in words for whatever reasons. However, depending on individual cases, play therapy might not always be helpful for people with difficulty in verbal expression.

Next, several play therapy techniques are easily adaptable for dance/movement therapy sessions because both approaches involve props and physical activities. However, since play therapy is mostly for the treatment of children, it might be challenging for me to use it solely in therapy. I have teaching experiences for both children and adults, but no matter where and what I teach, I always find myself teaching adults eventually, and I also feel that I am more at ease when dealing with adults. Moreover, it is essential for play therapists to thoroughly understand child psychology, but I am not particularly interested in this subject, neither have I any experiences of counseling children. Therefore, I might not be an effective play therapist for children. If I truly have the opportunity to conduct play therapy, I would like to apply it on adult clients and groups.

Finally, I think that anyone who considers becoming a play therapist should have a Christ-like attitude, as described in the following biblical passage: “Then they also brought infants to Him that He might touch them; but when the disciples saw it, they rebuked them. But Jesus called them to Him and said, ‘Let the little children come to Me, and do not forbid them; for of such is the kingdom of God. Assuredly, I say to you, whoever does not receive the kingdom of God as a little child will be no means enter it’.” (Luke 18:15-17).

[References]
Association for Play Therapy, Inc. (2005). Play therapy. In Association for Play Therapy, Inc. Website. Retrieved January 9, 2006 from http://www.a4pt.org/

British Association of Play Therapists (2004). A history of play therapy. In British Association of Play Therapists Website. Retrieved January 9, 2006 from http://www.bapt.info/historyofpt.htm

Canadian Association for Child and Play Therapy (2004). About play therapy. In Canadian Association for Child and Play Therapy Website. Retrieved January 9, 2006 from http://www.cacpt.com/

Drisko, J. W. (2005). A short history of play therapy. In Social Work Resources. Retrieved January 9, 2006 from http://sophia.smith.edu/~jdrisko/playtimeline.htm

Landreth, G. L. (2002). Play therapy: The art of the relationship. (2nd ed.) London: Brunner-Routledge.

Luke. Holy Bible: Thompson Chain-Reference Study Bible. (1997). Indianapolis, IN: B. B. Kirkbride Bible Company, Inc.

Sharf, R. (2004). Theories of psychotherapy and counseling. (3rd ed.) Pacific Grove, CA: Brooks/Cole.

Taichung City Government (2004). Rehabilitation on the 921 Earthquake. In Taichung City Government Website. Retrieved January 9, 2006 from http://www.tccg.gov.tw/sys/SM_theme?page=3ff23ecf

Webb, N. B. (1999). Play therapy with children in crisis: Individual, group, and family treatment. (2nd ed.) New York, NY: The Guilford Press.

Yang, L. C. (2006). Achievements of the second-term play therapy group program. Autism Society Taiwan, R. O. C. Newsletter, 207(6-9).

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