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Unimaginative and Literal Play
Repetition and Compulsion
Play Therapy Research Evaluation
Although clear and consistent definitions of abuse and neglect are starting to appear in the literature (Allers & Benjack, 1991; Burgess, 1985; Sgroi, 1982), of the 22 PT articles reviewed, only 4 provided a working definition of abuse and neglect. Unfortunately, these four definitions varied greatly. For instance, researchers such as Howard (1986) either created a specific definition for the area they were investigating or referred to preexisting, published definitions. Researchers such as Terr (1981) specifically described the abusive and neglectful circumstance(s). Others, such as Fagot et al. (1988) and TaylorMitchum (1987), failed to define childhood abuse and neglect in their reports. Until researchers in this area adopt and adhere to uniform and consistent definitions, research outcomes will continue to vary from investigation to investigation based on the individual researcher's experience with neglect and abuse.
Similarly, the definition of PT varied widely in the studies reviewed. Of the 22 studies examined, six primarily defined their work based on the fundamental PT guidelines of Axline (1947) or Landreth (1982). Five other researchers used the term play therapy but provided descriptions of work that represented more individual and unique therapeutic approaches to the use of play (e.g., Federation, 1986; Jernberg, 1979; McFadden, 1986). The remaining 11 studies failed to provide a specific definition of PT. The empirical validation of PT will require the consistent definition and application of play as a clinical treatment. Although therapists working from various theoretical orientations may have differing conceptualizations of the behavioral or emotive processes activated in play, the overall definition of PT must be consensually defined if research is to validate its utility as a therapeutic approach.
Another limitation of the PT and abuse and neglect research is the variability in the training of professionals using play in a clinical and research setting. Chan and Left (1988) stated, "(D)epending on the institutional organization, various caregivers, such as the child psychiatrist, child psychologist, pediatric social worker, and/or mental health nurse clinician, may use therapeutic play and/or play therapy" (p. 170). Although these health professionals may use play therapeutically, the mere use of play in and of itself is insufficient to qualify as PT. In reviewing the literature, we found four articles appropriately defining the role of a play therapist (e.g., In & McDermott, 1976; West, 1983) and five articles describing the general role of a helping professional who is using play therapeutically (e.g., Burch, 1980; Chan & Leff, 1988). The remaining articles did not describe the role of the professional so that we could evaluate the professional's training. Regardless of the clinician's theoretical orientation or background, the consistent training of therapists is essential to minimize the differential application of play in subsequent research. Consistent training, such as that suggested by Landreth (1991), would help to standardize research efforts and reduce outcome variability between studies.
Along with the variability in both definition and training, researchers have reported the use of nonstandard materials and modes in their study of abused and neglected children (Harper, 1991; Sinason, 1988). Although there may be a need for materials that are particularly sensitive to the issues and deficits of the traumatized child, research has failed to document which, if any, of the standard PT materials (Landreth, 1985) may be effective. Of those articles reviewed, only five listed all or most of the materials used in the research study (e.g., Nicol et al., 1988; West, 1983). The remaining articles either highlighted a few items or failed to mention any of the materials used. Similarly, variations in the use of different PT modalities (e.g., individual versus group, nondirected versus directed) create problems in the comparison and synthesis of research information (e.g., Fagot et al., 1989; Jernberg, 1979; TaylorMitchum, 1987). The standardization of PT materials and modes is essential if future research is expected to evaluate and extend the existing body of knowledge.
Most of the research on PT and childhood abuse and neglect has relied on nonstatistical observations using single cases or small-group samples (fewer than 12). In studies investigating larger groups, researchers failed to incorporate comparative control groups (Martin & Beezley, 1977; Nicol et al., 1988), suffered weak statistical power (Fagot et al., 1988), experienced low interrater reliability (Howard, 1986), or collected highly subjective data (Harper, 1991). Clearly, investigators must design research that encourages the collection of objective and relevant PT data and ensures the opportunity for powerful and descriptive statistical analysis.
Phillips (1985) summarized the observed research deficits most clearly. He stated, "What play therapy needs is a systematic program of research that clearly sets out its hypotheses, designs well controlled-studies, carefully selects subjects, measures meaningful outcome, and uses appropriate and informative statistics" (p. 758). Unfortunately, based on this review of the PT and childhood abuse and neglect research, there is little indication that Phillips's (1985) astute recommendations have made an impact.
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