What is play therapy?
Plato said “you can discover more about a person in an hour of play than in a year of conversation.” Many years later, in 1903, Friedrich Fröbel, who developed the concept of the kindergarten, observed “play is the highest development in childhood, for it alone is the free expression of what is in the child’s soul … children’s play is not mere sport. It is full of meaning.”
While some parents have it easy, others have bigger challenges than they know how to deal with. Without any formal training in this area, it can be difficult for parents to deal skilfully with their child when challenges arise, especially when their child is not yet able to express themself through words and parents are unable to mind read.
“You can watch as many DVDs and read as many books as you can about how to support your child when they have an issue,” says Sonja Walker, Director of Kids First Children Services, “but having a professional who’s not emotionally engaged can be hugely beneficial for families. Kids don’t learn by osmosis just by us throwing them into the play ground with the other kids – some children need more attention and support.”
What is play therapy?
One of the ways in which therapists continue to support children and their families through challenges is through play therapy. Play therapy is used for children as young as nine months up to 11 years old. It works in much the same way as counselling or psychotherapy does for adults, but instead of the child sitting down and talking through their problems, they play their problems out.
“Therapy’s about having fun as well and if a child isn’t having fun then it’s hard to get them to enjoy the process,” says Ros Osling, speech pathologist. So when children have difficulty expressing their experiences and emotions in words, play therapy is a medium for them to do this. Through play they can also explore relationships, develop social skills and express their desires. In some approaches rewards may also be given to encourage them further in being part of a process that might otherwise seem boring.
By observing a child play, play therapists are often able to determine possible causes for the child’s disturbed behaviour. The objects they choose and the patterns of play, as well as the child’s willingness to interact with the therapist, can be used to understand the underlying reasons for how they behave both inside and outside the sessions.
For three-year-old Malie, who was diagnosed with Autistic Spectrum Disorder (ASD), therapy started at the age of 16 months. Her mum, Fiona Chadwick, says, “She has come ahead in leaps and bounds since having therapy. Twelve months ago she wouldn’t have looked at anyone she didn’t know. She wouldn’t have engaged in play with her parents or anyone else. She just wanted to sit and do her own thing and was in her own world. Malie wasn’t even interested in playing with her twin sister. Now they play together, they share, they take turns doing things. Malie loves to play all the time now. She’s just a happy, joyful little girl.”
Through play therapy, children can be supported as they tackle various challenges, including adjusting to separation and divorce, making friends, dealing with excessive anger, fear, sadness, worry and shyness, school difficulties, abuse and neglect, adjusting socially, sleeping and eating difficulties, dealing with grief and loss as well as ASD, to name a few.
Studies show that one in 160 Australians have ASD, the effects of which can be minimised by early diagnosis and with the right interventions, including play therapy. “Through play therapy you’re going to the kid’s level,” says Fiona, “to what interests them as opposed to trying to bring them into your world. It teaches them to relate to other people … and to do that through fun and through games is really fantastic.”
Who leads whom?
Play therapy can be either directive (with the therapist guiding and interpreting the child’s play) or child-directive, where the child guides the direction of the therapy. In the latter approach, the therapist enters the child’s world, following the child’s lead, developing a safe place and a relationship of trust. Two such types of play therapy are Filial play therapy and Watch, Wait Wonder (WWW).
Filial therapy, developed by Bernard and Louise Guerney, was an innovation in play therapy during the 1960s. A session may include you and your children sitting with a therapist and coming up with three things your family wants to improve. An example of the three things could be no hitting, no swearing and doing your jobs around the home. Additionally, something that gets everyone motivated might be agreed on, too, such as aiming for a family holiday in six months time. The family is then encouraged to stick to this for two weeks, after which the situation is reviewed when they return for a family meeting.
In WWW the child is the most important person and is in complete control of the situation. In a session, the mother gets down on the floor with her child to observe her child’s self-initiated activity, interacting only if her child initiates it, remaining physically accessible to them. Sydney paediatrician Dr Zilibowitz says children communicate in their play, and when parents sit back and observe, it allows their children to develop the themes of their inner world.
It’s the perfect environment for children to express themselves completely. No one nags, directs, criticises or goads them. It’s not uncommon for a mother to feel anxious, though, if following her child’s lead is a new approach. Also, the themes children communicate are typically about their relationship with a parent, so parents need to be able to accept what’s acted out.
While the infant’s activity is regarded as an important catalyst, the primary work in WWW is between the mother and the therapist. After being the observer, the mother is asked to discuss her observations and experiences. At no point does the therapist instruct, give advice or interpret the child’s activity or play, but merely provides a safe, supportive environment where the mother can express what she observed and how it reflects on their relationship.
For parents who find it difficult to interact with their children, don’t know how to interact with their children or are too tired after a long, hard day at work, this program assists them in gaining a better understanding of what their child is feeling and the relationship between them. The idea is that the child’s behaviour should improve as they gain an outlet for expressing their inner feelings while having their mother’s full attention.
Setting it up at home
If you want to implement some of the WWW guidelines in your home, put a selection of toys on the floor of a room where you and your child won’t be disturbed for 30 minutes. (Toys might include dinosaurs, whose prehistoric nature seems to embody the aggression a child may be feeling, a little doll family, building blocks, a telephone, bus, car, aeroplane, train or any other modes of transport). Then go into the room with your child and say something like: “Here are some toys; you can play with whatever you like.” Close the door, sit down and watch your child play.
It’s important that you don’t interrupt or intervene; just observe and only become involved as your child requests. It’s also important that you be fully present, watching and responding, but not taking any initiative. When you don’t interrupt, but stay as focused as possible, something special evolves and the opportunity arises for you to learn a lot about your child and yourself through observing how your child uses that time. If you find it’s hard for you, don’t worry. It usually takes a few attempts before parents can do this without stepping in, because it’s second nature for them to instruct, teach and question.
Where do they happen?
Play therapy sessions can be held in a playroom that has a range of carefully selected toys and materials, but could also take place in your home or even a hospital. Monique Simpson, autism specialist and speech pathologist who specialises in Connect therapy, says, “I love carrying out sessions in my clients’ homes because I get to know the family dynamics very quickly and incorporate therapy that respects the core values of the family into their day-to-day activities.”
For Ros, play therapy sessions are usually in a room. If the session is in the family’s home, “It might be in Mum and Dad’s bedroom because there’s the bed and it’s nice and soft and comfy, but there’s not whole lot of different objects that the child will be distracted by.” Initially, with a child who’s not engaging with other people, Ros would have very little in the room at all. The reason for this is to encourage the child to engage with her or with her mum or dad rather than objects. “If you can’t look at and interact with someone it’s very difficult to learn social skills and language.”
Play therapy for children with ASD
For an autistic child, because everything revolves around them, the balance between the child’s world and the adult’s world is out of kilter. They don’t engage with people and don’t understand that other people have a point of view. In these cases, play therapy is initially about following the child’s lead. It’s child-directed, so the play will be about imitating and copying what the child is doing. “By doing that, you’re engaging the child,” says Ros. “Then you tip the scale so you get a balance between what the child’s doing and what the adult is doing.” The child then typically starts imitating more of what the adult is doing and by doing that you’re developing the idea of joint attention and then you can teach a child.
For Rebecca Schoemaker, play therapy has had a significant impact on her daughter Faith, who once had no idea about emotions or feelings. Through a play-based therapy called Bright Start, Faith has learnt about them. For Faith, as for other children with ASD, feeling and expressing emotions doesn’t come as naturally as it does to other children. “It’s been really, really hard,” says Rebecca, “but the therapy has helped her to start having empathy for others rather than just walking past. It’s really helped her to understand other children and to not to be so withdrawn.”
Through play therapy, “Parents learn to take themselves back from their adult communication skills and to put strategies in place that support their children, speaking to their child in a way their child can understand. It’s often about parents learning to get their child’s attention first and then talking to them in a quiet, low voice in words they understand,” says Sonja.
Know your child
A baby’s earliest forms of communication — during the first three months of life — are not easy to notice and many parents simply miss out by not knowing what to look for. To learn how to behave, a child first needs to have their communication needs met and, in order for that to happen, parents need to be able to understand what their child needs.
Connect therapy helps families understand what’s going on with their child by getting down to their level. The starting point here is often learning to interpret their children’s gestures. It could be a prolonged gaze, a smile or gurgle. Whatever it is, subtle movements and sounds are important attempts by infants to communicate and engage. “Connect emphasises parental involvement, is very parent friendly and uses a lot of common sense,” says Sonja.
Is your child struggling with language development?
“Communication and behaviour are intrinsically linked. Often kids’ behavioural problems come about because they’re unable to express themselves and have language delays or communication issues. Through Connect, children’s communication skills and sensory skills are developed, which makes it great for kids finding it difficult to manage their emotions and express themselves.
For parents of kids 2–5 years of age who are struggling with language development, Carissa Louwen, speech pathologist, recommends Parent Child Interaction therapy. It’s great for children with receptive and expressive language delay/disorder, global learning difficulties including language delay, and ASD.
At an initial Parent Child Interaction therapy appointment, the parent and child play together as they normally would at home. The difference is that here it is videotaped and analysed by the parent and speech pathologist, who then identifies what the parent is doing well as well as areas for improvement. The parent’s role is very interactive. They not only make decisions on the strategies they’d like to focus on for the week (with guidance from the speech pathologist, of course), but then play with their child again while focusing on that strategy.
Strategies may include following the child’s lead, letting the child choose their own toy, sitting where the child can see them, giving the child enough time to talk, listening to what the child is saying by looking, answering and repeating, commenting on what the child’s doing, not asking questions, praising the child, talking slowly and waiting for the child to initiate communication through words, sound, looking, gestures etc. It’s often thought that if a child is not talking, an adult should talk more to encourage their child to talk, but research suggests the contrary.
Each week, when visiting the speech pathologist, the strategy is reviewed via videotaping and the parent analyses how they went. The parent is the one who then decides whether they’ve been successful with the strategy and whether they’d like to continue with it or would like to choose another one.
Between appointments, parents are encouraged to play with their child for 10 minutes a day, focusing on the strategy identified in the appointment. This is so they become confident using the strategy and, hopefully, then integrate it in their everyday interaction with their child.
The main principle of this therapy is the partnership with parents, enhancing their knowledge and understanding of their child with the therapist’s support. In this way, strategies are developed to promote language development in their child.
Make it a family affair
And last but not least, you have the option of making play therapy a family affair. In a family play therapy session your family could be given toys, miniature figures, clay, paint, books and puzzles and encouraged to play and make up stories or draw pictures about how you’d like things to be in your family. Together, you listen to each other and build on your stories, puzzles or pictures while the facilitator draws on your family’s strengths to find playful solutions to achieve your goals. Talking is not the most important form of communication — playing together is the key.