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Sigmund Freud in 1909 was the first to use play to uncover his client’s unconscious fears and concerns. Hermine Hug-Helimuth began using play as a part of her treatment of children in 1920 (Hug-Hellmuth, 1921) and 10 years later, Melanie Klein and Anna Freud formulated the theory and practice of psychoanalytic play therapy. This type of play therapy continues to be one of the most respected forms of child therapy, usually conducted by analysts.
Psychoanalytic Play Therapy
Freud and Klein took the basic concept of free association, one of the basic precepts of adult analysis, and in its place substituted the child’s natural tendency to play (Nagera, 1980). They proposed that play uncovered the child’s unconscious conflicts and desires and that play was the child’s way of free-associating. While Klein proposed that the child’s play is "fully equivalent" to the adult’s free associations and "equally available for interpretation," Freud’s theory viewed play not as an equivalent to adult free associations but as an ego-mediated mode of behavior "yielding a substantial body of data" but requiring supplementation from a variety of sources, including parents (Esman, 1983). Psychoanalytic play therapy, predicated on the analysis of resistance and transference, emphasizes the use of interpretation, recognizing the child’s ability to use play symbolically to manifest internal concerns. Nagera (1980) documents that even though significant differences existed in the theoretical tenets of Freud and Klein in the beginning, throughout the years there has been more of a convergence between the two theories. Fries (1937), a student of Anna Freud’s, delineates the distinctions between the two theories, emphasizing Freud’s preference to withhold interpretation.
Structured Play Therapies
Anna Freud had initially found the use of affective release useful, but on the basis of later experience she encouraged this type of work only in cases of severe traumatic neuroses. David Levy (1939), stimulated by Anna Freud’s conclusion and by Sigmund Freud’s concept of "repetition compulsion," introduced the concept of "release therapy" for children who had experienced trauma. Levy helped the child recreate the traumatic event through play. The goal of this type of play was to help the child assimilate the negative thoughts and feelings associated with the trauma by reenacting it over and over again. Levy cautioned against using this technique too early in therapy, before a strong therapeutic relationship had been formed. In addition, he took care to avoid "flooding," in which the child is overcome by strong emotions and thus unable to assimilate them.
Other well-known contributors to the literature on structured therapies include Hambidge and Solomon. Solomon (1938) thought that helping a child express rage and fear through play without experiencing the feared negative consequences would have an abreactive effect. Hambidge (1955) was even more directive than Levy, who provided toys to facilitate the child’s recreation of the trauma: Hambidge facilitated the child’s abreaction by directly recreating the event or life situation in play.
Leadership, preferably with male and female co-therapists, involves developing cohesiveness, identifying goals for the group, showing the group how to function, keeping the group task-oriented, serving as a model, and representing a value system. In carrying out these tasks, the leader may offer clarification of reality analysis of transactions, brief educational input, empathic statements acknowledging his own feelings and those of members, and at times delineating the feeling states at hand in the group. (p. 129)
Group therapy has traditionally been believed to have application to the treatment of abusive parents (Kempe & Helfer, 1980). A treatment approach used effectively with abusive parents is known as Parents Anonymous (PA), founded in California in 1970. PA uses a formerly abusive parent as a group facilitator in addition to the mental health professional. There are currently over 1,200 PA groups in the United States.
Another very well-known treatment model, Parents United, relies heavily on the group format. Parents United was established in 1975 by Dr. Hank Giarretto as the self-help component of the Child Sexual Abuse Treatment Program (Giarretto, Giarretto, & Sgroi, 1984), now known as the Community as Extended Family. Separate groups are formed for the incestuous parents and for the non-abusive partners. The children’s groups are known as Daughters and Sons United, and the groups for adult survivors are known as Adults Molested as Children (AMAC) groups. There are currently over 135 active Parents United programs across the United States.
• Define acceptable behavior of group members and introduce a respect for boundaries.
Another pilot project, by Corder, Haizlip, and DeBoer (1990), used structured group therapy to treat sexually abused children ages 6 to 8, and focused on issues comparable to those of Mandell and associates. The goals in the pilot project included integrating the trauma, improving self-esteem, improving problem-solving skills, self-protection for the future, improving ability to seek help, and enhancement of the child’s relationship to the nonabusive parent.
Group therapy is not without its controversy. I have often heard the concern that the group might inadvertently encourage the child to overidentify with the victim role and that groups have the potential of "contaminating" one child with the emotional concerns of another. Yet another concern, which I share, is that sometimes groups are run in random ways, go on for indefinite periods of time, lack clear goals, and suffer from inconsistent and inexperienced leadership. However, these concerns are discussed in the book by Man-dell and associates and do not undermine the potential benefits of the group experience.
Sand Tray Therapy
Parent–Child Interaction Therapy: current perspectives
- Lieneman, C. C., Brabson, L. A., Highlander, A., Wallace, N. M., & McNeil, C. B. (2017). Parent-Child Interaction Therapy: current perspectives. Psychology research and behavior management, 10, 239–256. doi:10.2147/PRBM.S91200..
Enactive account of pretend play and its application to therapy
- Rucinska, Z., & Reijmers, E. (2015). Enactive account of pretend play and its application to therapy. Frontiers in psychology, 6, 175. doi:10.3389/fpsyg.2015.00175.
Reflection Exercise #12
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