The Therapy of Play
- Author:
Kathleen M. Todd, M.B., Ch.B., D.P.M.
“7” Me objea ‘W to.prove nor t0 explain. It is to accede to vision. If we are to have vision we must learn to participate ?J the vision. The apprenticeship is hard.” Antoine de Saint-Exupery. . -v^woiogical medicine has made Sre^j? stvpars smce the beginning of this century; of lattta-year lhe searchlight has been turned on the clhi!Id, an many studies have been made of his intellec eniotional processes.
We now know that the roots of nervous and mental disturbance are laid down in childhood and that the numerous psychological disorders of the adult man can be traced back to their beginnings in the young child. This knowledge has shifted the focus from the adult to the child, and research is attempting to devise new ways of exploring the hidden places of the child mind. Out of this has arisen the Child Guidance Clinic, and many varieties of treatment including therapy through play.
What is “play therapy”? It appears there is immense confusion in the minds of many as to its meaning. What are its methods, who is competent to undertake it, and under what conditions is it carried out in Child Guidance Clinics and private psychological practice ? It seems opportune to attempt to clarify its meaning and functions, to give some limitation and definition to the word ” playtherapy “, and to try to indicate in what way it fits as one approach into the larger scheme of treatment of the child mind, made by those who seek to ameliorate or cure symptoms of nervous disorders in childhood. What was the usual picture conjured up in the past in the mind of the average worker in psychological medicine when he heard the word ” playtherapy ” ? I think he visualized a play room, probably large, a group of disturbed children, materials such as a tray of sand and water, toys including dolls and dolls’ houses, and animals? from the farmyard to the jungle; a good deal of noise and aggressive outbursts, and in the background an adult called a “play therapist” who to a greater or lesser extent directed, guided, encouraged, or more rarely checked the primitive urges of the group as each child expressed in a multiplicity of shapes and forms the wide range of his emotional distortions and deviations. In the hands of the less experienced, aggression appeared to be encouraged to the neglect of the other instincts, and ” selfexpression ” was at its maximum. This kind of Group gives a false picture of Child Guidance work; it belittles the commonsense and sense of values of psychologists, and is not countenanced by a well trained staff.
Group work has its place in the Child Guidance field, but its limits should be defined and its sphere of usefulness made clear. Its main value lies in observation of the behaviour of children in a new and unfamiliar setting, where conventional rules are not imposed and the ” natural ” child is allowed to emerge. A trained worker, not necessarily a therapist, may give significant information concerning the ego and social reactions of a child from a study of his behaviour in a series of play sessions with other children, and her report furnishes the psychiatrist with useful supplementary information as a prelude to his individual interview with the child.
Then again a group may be instrumental in socializing a child whose main problem lies in his inability to fit himself into the social setting corresponding to his age. This may be due to a variety of causes, mainly environmental, e.g. deprivation by isolation or illness, too indulgent or protective an environment, or too harsh an atmosphere causing thwarted rebellion and a bullying attitude to younger children. As he plays, the child learns to take the measure of his feelings, his loves and hates, and* through familiarity, not to be afraid of their expreS’ sion: he comes to know how to assert himselt without fear, how to give way without loss oI prestige. If his nervous symptoms are due to fflOf? deep-seated causes, socializing is dealing only the surface of his problem and individual treatment by a trained therapist is then essential. Group work should ideally always be carried ouj by workers trained in a Child Guidance Clinic and under the aegis of the psychiatrist, but it is not <j specific treatment which could in any sense be call#} psychotherapy; perhaps the word “play therapy had better not be used in connection with sucl1 groups. .
If the play group is mainly observational an. socializing and not specifically therapeutic, whatlS ” play therapy ” and what part does it play in the whole field of psychological therapy ? f A child like an adult possesses a mind capable ot thinking, feeling, willing and being; he com* municates with others by means of speech as does the adult, but his speech is neither so developed, s? controlled, nor can he use it with the same exactitude to express his individuality and his needs, this ot course varying with his age, intelligence and specify language capacity. The child, however, has a richer and more readily accessible phantasy We which is not yet relegated to its subsidiary place by the adult rational functions. In his earlier years he has a remarkable ability to switch backwards and forwards from reality, i.e. his contact with the reaj objective world, to phantasy?his own persona’ inner private world. This can be observed by anyone watching a child shedding the role of the fairy prince when called to wash his hands f?r supper and bed. This lively and vivid phantasy the possession of every small child, is not in ah respects the same quality as imagination, the possession of the few, although in the creative child endowed with artistic gifts, the two intermingle The phantasy life of the young child is at its richest up to 7 or 8 years when it is partially replaced by realistic attitudes and drives towards the world ol objects.
The small child expresses his phantasy easily and with a sense of fun and enjoyment and he finds it a ready medium for emotional expression. He is as yet undeterred by civilized restrictions and standards, so that his feeling life externalizes itseli freely and easily on to material objects and imaging tive scenes. This emotional life which in adult treatment is explored mainly through dreams and free association, expresses itself in the child through a much greater variety of media, but broadly through two fundamental activities, i.e. speech and bodily activity including play. The psychiatrist recognizing this, utilizes for therapeutic ends such material as sand and all the forms of messy play* toys, especially dolls in family groups, animals* bricks, etc., but also paints and pencils for drawing and painting, clay and plasticine for modelling. addition he uses play of the dramatic type, the a<^i”””uuin2 which the child can so readily teach16 ^ r?^es Parent ar)d child, child and Qr ner, animals in the forest, policeman and prisoner ex any other combination of characters which AmSSeS conscious or unconscious problem. and?n??t Pretending games are the popular cooking games specially loved by the toddler and thrnU t0 the therapist because of the light they anH on habit training, lavatory fears, food fads Th ^ears 0fte . dreams, too, and his dream world is thatnulnextr’cably mixed with his daytime world, so Co ~?e may relate the beginning of a dream and His h 0hviously resorting to his phantasy. as vvareaums are a valuable index to his personality, ?par that of the precious only little girl of adored child1 wh?.dreamt she was a clinging vine. The plav sw*n.g ‘n ^e same interview from dramatic draw t y materials. He may sit down and and h? ^ah?rate his play or to illustrate a dream, remaif ^umines all with talk, a composite of siinerfiS- drawn from the deeper and the more build layers of his mind. In one interview his anoth8 m the sand is silent and absorbed, in evpr, er there is a running commentary illustrating ItV?i?Ve *n game.
and it capacity in the child, his love of phantasy and tS exPression in play, so familiar to parents therae^c .s’ which is utilized by the modern childdiSor^1St n his investigation of psychological Varv ur an4 the causation of symptoms. Opinions child ?11 *s this writer’s view that therapy in the rapidiaS ln aduh? reaches its desired goal more with th anc successfully if it is individual, i.e. alone the ad 1 t^lerapist, for the child is just as unlikely as of otL to divulge his deepest self in the presence temDn ?’ so that groups even though they econ~ranly ahsorb numbers are in the end not Th cal ?f time.
childrrC are t^vo types of persons qualified to treat can en offering from nervous disorders, and neither tfai . arry out treatment without a specialized (ingwhich extends over several years. qualifi h psychiatrist who is a medically Psvch i ?an or woman with further experience in (2) disorders of childhood.
qualifi h ‘aY therapist who is not medically childr ^ut *s sPecially trained in the treatment of be fa Both these groups of therapists should (talk !ar with all the above methods of treatment syrnh r rnaterials in both realistic and drawi? sPheres, play of dramatic type and frequp1 and not confine themselves as has been throiiou” ln the past to one approach, e.g. only call^ speech, or only through what has been Let it Klay therapy “?
in the emphasized that there is no special magic Sroun ra?y through play, nor is there any special Possec Persons in Child Guidance Clinics who thro KS?me mysterious gift in utilizing it. Therapy thera ? P’ay *s Part ?f the equipment of all child tool pists?doctor and lay, but it is merely one and should not be dignified by a separate y name. It would clarify our thought if we were to d call all treatment “clinical psychology” which r would include every method of treatment, all the i above materials and methods being designed to the same end, that of modification or cure of nervous I and behaviour disorder in the child. The art of i therapy lies not in any magic properties inherent in r the toys themselves, nor in any specific atmosphere > derived from a room in a Clinic called a Playroom, but in the skill, wisdom and experience of the > therapist himself.
> Every modern child-therapist, whether medical or I lay, has a collection of suitable materials in his consulting room which are as important to him and his work as the stethoscope is to the physician, and it is of little moment whether he calls his room a playroom or not. In the future, the term Clinical Psychologist might be used broadly to include doctor-therapist and lay-therapist, although the word ” Child psychiatrist ” will always retain its specific meaning: the terms “play therapy” and “play therapist” could then disappear into oblivion and take with them the confusion they have engendered.
Every child therapist should be trained to treat children of all ages, toddlers of 2 to 5 years in whom of course play is the method of election, children of school age, and adolescents with whom talk is the more usual but not invariable vehicle for therapy. In a large Clinic it is possible to select cases of certain ages to suit the special capacities of individual therapists particularly gifted with certain age groups and one or other sex, but during training it must be emphasized that all therapists, doctor and lay, should be familiar with the mind processes of children of all ages, not only to fit themselves to cover a wide field of work in the Clinic employing them, but also to ensure that when they take more responsible positions they can collaborate with colleagues in every branch of child work.
It is at the first interview when the child is examined by the psychiatrist that the particular type of treatment most suitable to the child’s nervous illness and most fruitful of results is decided upon. There are certain constitutional lacks, intellectual and temperamental, which preclude treatment along psych o-therapeutic lines, particularly deeper therapy. The nature of the child’s disorder and its causation largely determine the type of treatment chosen. Broadly speaking, disorders which are the result of a recent precipitating trauma are more likely to respond to short treatment: many of the anxiety states fit into this category, whereas an obsessional character change imperceptibly developing over a period of years may require long and intensive psycho-therapy of the analytic type.
The choice of treatment as to its length, depth of investigation and method of approach depends upon several factors, e.g. the severity of the disorder, the degree to which the personality has deviated from the normal, the child’s innate make-up, and lastly his insight. This quality of insight is not an equivalent of intelligence; it is dependent upon an awareness of inner processes, a capacity to view one’s subjective life with a discerning eye. It has in it something of vision, of intuition and a willingness to explore the interstices of one’s mind. Many young children, not necessarily of superior intelligence, are highly endowed with this quality; many intellectual adults are denied it, but neither the nature of his disorder nor the child’s insight determine whether or not play shall be introduced into his treatment.
Therapy deals with conscious and unconscious processes of mind, the therapist being the judge as to what extent unconscious regions of the psyche are to be explored. All treatment, including adult treatment, may broadly be divided into two types:
(1) Suggestion, persuasion, re-education?mainly but not entirely on conscious and preconscious levels.
(2) More or less analytic treatment involving the investigation of the unconscious whether interpretation is employed or not. Play material may or may not be used in both these types of treatment and at any age. The child comes into the room where a collection of material is readily accessible; he chooses for himself what pleases his fancy or satisfies his needs. He may reject what offends his image of himself or his family standards, e.g. the child who does not like to get his hands dirty with sand. He does not know how revealing his choices are or how dominated by hidden conflicts his selection may be. Most young children are drawn to sand and water and the delights of building something; this something is often of great significance in divulging his inner mind. There is the child who builds a lighthouse far out at sea and says dejectedly that the light has gone out and the sailors will all be killed on the rocks: another builds enclosing walls of sand higher and higher and then places his fort at the top guarded by guns with a solitary soldier inside. A third child crowds his scene with every toy and figure in the room, driven by his obsessional mould of mind to include everything, and a fourth builds a jolly house and garden and fits it out with a family, a cat and dog and farm animals. Then again he may prefer to draw or paint, and a picture emerges which unknown to him clearly presents the therapist with the whole family setting and its emotional complexities, e.g. a little girl who drew a horse on which were riding four people but they were slipping down its tail. At the side stood a helpless figure?she called the latter figure the father and those on horseback the mother and the children; it is obvious what the child felt about the incapacity of her parents and the uncertainty of life for children in their care. The little patient may play for a time and as the friendly atmosphere of toys, reminiscent of the nursery, draws forth his confidence, he may settle himself in a chair and relate in words the difficulties which beset him. Few young children can do this, however. In most the interview alternates between silent play, sometimes symbolic, sometimes realistic, and play that is interspersed with talk, coherent o incoherent, racy or solemn, his talk serving either a an illustration to his play, or as a response interpretations that may be given. Interpretation1 the most difficult field of the therapist’s art; by it doctor makes known to the child the content of n’ more deeply hidden fears and worries, his hates an, loves, his unsatisfied longings, his conflicts an anxieties. This may be done by words or “j gestures, by direct language or indirect communis’ tion. Herein lies the art of the therapist, and heI^ are expressed his qualities of wisdom, human undef’ standing and imaginative vision. Depending up0 the personality of the therapist, interpretation take_ many forms. Suffice it to say that its skilful one of the most valuable of the therapist’s tools, tha it is a fine-edged tool and can be kept sharp-poin^ only by constant use. It above all should be in w hands only of the highly trained.
The ability to play and use toy material as medium of expression is not restricted to any a?> group. It is not true that only young childre ” play ” and older children talk, and it is errone?J| to imagine, as many do, that “play therapy” is fj province of the lay therapist and talk with the olde child that of the doctor therapist. A boy of 13 can play out a complex emotional problem in sand> another of 9 can carry through his whole treating by means of speech, with perhaps drawings to il’uS^ trate his talk as he goes along. One little boy retreated into a complete phantasy machinery wor where every human function including birth ^ mechanized; his drawings were expressive and j11. vocabulary wide and exact, and treatment needs no other medium for its successful termination his particular but rather unusual case. Again 1 should be reiterated that both the doctor and W1. lay therapist should be competent to deal with a ages and every variety of medium.
Play material is there for the child throughout ni whole treatment; he may express himself aggr^ sively against figures which symbolically stand J? parents or teachers who have ill-used him: he, 0 more likely she, may pour out her locked ^ maternal tenderness on a family of dolls. The may depict an imaginative account of unfulfil’e adventurous longings in a ” story ” in the sand trjtf with animals and ” people “, then translate tjj same story into dramatic play with himself in tflg chief part and the therapist perhaps in sotf subsidiary role. Play is always guided by ^ therapist who with experience knows best how 1 direct it to promote recovery but his role is neV.?j wholly active or wholly passive; he leaves the ch1’ largely to his own choice of materials, yet help him to find himself when lost, frustrated or w against insoluble psychic barriers.
Play should never be of any set or rigid patteIj^ never confined, because of the predilections of ^ therapist, to one set of material, nor dependent upfj, a wealth of complicated material. A young c^lL with the aid of his phantasy can express all richness of his emotional life with nothing m?r anim ^CW sma^ dolls, some wet sand, a dozen eve-, -J? Preferably some domestic and some wild? brioi-mutilated as many are in wartime?some ‘ matp - ?r pegs and his own hands. These simple guid^K P’US child’s capacity for dramatization I intnV Merest, originality, keen observation, the th?n a-nc* we^ timed word of interpretation by the i .ei!aP^st are the ground plan on which is built r>,n. ricale pattern of the therapy of play. which therapy then, is a wide field of treatment of for an P’a-y ” s on’y one approach. Play is not child Part’cular group of children, or for the young excli, -?r imaginative child only, nor is it the I treatSlVC to?^ PeoP’e w^h some occult gift. [ tion nt on Psychotherapeutic lines is a combinaI denenH an art anc a technique; an art in that it is oent on the personality and gifts of the therapist, a technique because its confines lie within certain limits and it can be taught to others; and part of the modern therapist’s technique is that of play.
It is because play is the natural expression of all children that the therapist has captured its spontaneity and fitted it into his therapeutic plan, but he remembers that there are many avenues into the territory of the child mind, that the future may reveal many more, and that unless he keeps his mind supple and his approach original, the child will not be left free to give up his secrets in the way best suited to his individuality. Play has opened the door to a large world of the child’s phantasy and imagination, but the fascination of its use must not blind the therapist to the other means by which the conscious and unconscious life can be reached.
Disclaimer
The historical material in this project falls into one of three categories for clearances and permissions:
Material currently under copyright, made available with a Creative Commons license chosen by the publisher.
Material that is in the public domain
Material identified by the Welcome Trust as an Orphan Work, made available with a Creative Commons Attribution-NonCommercial 4.0 International License.
While we are in the process of adding metadata to the articles, please check the article at its original source for specific copyrights.