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By carefully introducing the mother into the playroom where the child was being seen, we intended that each would learn to be more comfortable in the presence of the other. As we planned it, the process would be analogous to, or perhaps identical with, counterconditioning (Wolpe, 1958). The first step would be the encouragement of the patient's free, spontaneous play with a few rules as possible. During this time the mother would become accustomed to the situation by observation of the playroom activities and discussion with a second therapist. As soon as it seemed appropriate, we would bring the mother into the playroom, for brief periods at first, and encourage her to prompt the child's spontaneous play. We planned to terminate treatment after eight sessions at the most on the assumption that the mother would learn some skills that would generalize to the home.
The patient's teachers reported that she had done very well at school and that her work was neat, complete, and very accurate. However, her' teacher was concerned not only by the lying episodes but also that the patient had no friends in her school room. The patient's mother reported that a friend of hers, when asked for an opinion, had said that the patient was under too much pressure at home. This friend said that the patient was told to do too many things and given her choice too seldom. The patient's mother said that this was the way she ran her household. At home the patient might mutter or mumble defiance but would continue doing what she was told.
By the time the patient was brought to the Clinic for assessment and treatment, the lying had almost stopped. The patient's mother said that she was still concerned because she had become aware that the patient was not as happy as she should be. Detailed inquiries were made about family discipline. It was learned that the mother usually took the lead in disciplining the children, particularly towards the end of the day when she became irritable. She saw herself as being too hard on the patient and had tried to be more lenient, but found it very difficult.
Doll materials were used in order to evaluate the patient's attitudes towards both school and home. In doll play, which was structured by the therapist to involve a dispute between a parent doll and a little girl doll, the patient took the role of an obedient, submissive little girl. In doll play with a school situation, the patient had her doll chose to go to the library and read rather than go out and play with the other children. These and other indications suggested to us that the patient was not a severly disturbed little girl but that she had learned to inhibit much of the free, spontaneous emotional expression appropriate to a child of eight. Instead she showed an unusual concern with accuracy, neatness, and adult approval. We also learned that she could quickly relax and play boisterously in the playroom.
In the observation room the second therapist explained to the mother that in working with disturbed children it was important to keep the rules as simple as possible and to always explain the reasons for them honestly. When it appeared that the patient was playing happily and enthusiastically in the playroom, they knocked on the playroom door and explained that they would like to sit in and watch for a few minutes. The mother sat quietly to one side and did not say anything during this first time in the playroom. The two therapists talked with each other and with the child, ignoring the presence of the mother. After a very few minutes, the mother was again taken to the observation room where she and the second therapist watched the play. The mother said that she was impressed by the child's liveliness and enthusiasm in playing. Reasons for the child's greater spontaneity with therapist and the objectives of treatment with the child were discussed. It was pointed out that one of the objective of play therapy was to find out what things bothered the child and to help her with these. A useful technique was to notice the problems as they arose in play, make guesses at their meaning in the child's life, and then discuss them without necessarily expecting the child to participate in the discussion. If something important was hit upon, the reaction of the child often showed this was so.
During the second session the procedure was repeated with the length of time that the mother spent in the playroom increased. It became noticeable that the patient was somewhat more subdued when her mother was in the room, although she still played well. This was pointed out to the mother while in the observation room and the reasons for it discussed.
During the third session, while the mother and one therapist were observing, the patient became very exuberant. The necessity of limits were discussed with the mother, not only for the sake of the child but for the sake of the adult in the situation. It was pointed out that these limits might vary depending upon the child's needs and upon what the therapist would or could accept but that honest explanations for the limits should always be given.
During the fourth session, the mother stayed in the playroom during most of the session. The patient was somewhat more subdued at first, but became more relaxed as the hour went on. An effort was made to involve the mother in the play by having the therapist remain passive while encouraging the mother to respond to the child's leads. When the mother attempted to encourage the child to perform better, the child became frustrated and turned to something else. The therapist pointed out to both of them what had happened and what the effects had been. The therapist took a more active role until the child was playing happily again.
The fifth session
was also spent with the mother in the playroom during most of the hour. Again
an effort was made to keep the child as relaxed and free as possible while encouraging
the mother to participate naturally in the play. The effects and meaning of various
interactions between them were discussed with the intent of making the effects
of each upon the other as positive as possible.
Reflection Exercise #3
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