Innovative Play Therapy Approaches: Applications of the Play Therapy Dimensions Model

1. Innovative Play Therapy Approaches: Applications of the Play Therapy Dimensions Model Presented by: Lorri Yasenik, MSW, RSW (CPT-P) Ken Gardner, M.Sc., C.Psych (CPT-P)

2. WHAT IS THE DILEMMA? • Is one approach better than another? • My training is in one model of play therapy. • Is directiveness and nondirectiveness just part of a continuum? • Does personal fit between me and the model count? • What if I am supervised from one perspective?

3. WHY DO WE NEED AN ORGANIZING FRAMEWORK? Because…. • There is a trend toward a multitheoretical orientation • Decision-making guidelines are lacking • We need to identify important change mechanisms • We want to optimize the effectiveness of treatment

4. The Meaning of Play Children must be approached and understood from a developmental perspective. They must not be viewed as miniature adults. Their world is one of concrete realities and their experiences are often communicated through play. Unlike adults whose natural medium of communication is verbalization, the natural medium of communication for children is play activity. Garry Landreth, 1991

5. Play Therapy is… • “The systematic use of a theoretical model to establish an interpersonal process wherein trained play therapists use the therapeutic powers of play to help clients prevent or resolve psychosocial difficulties and achieve optimal growth and development.” Association for Play Therapy (2001)

6. Play Therapy does…… • Utilize core principles of child development • Consider the”whole child” – cognitive, social, spiritual & emotional functioning • Establish and monitor goals for change within a context of therapy stages • Value the relationship between the child and caregiver(s)

7. Play Therapy does not… • Impose adult models of therapy or change on the child • Believe in unlimited or open ended treatment • Use “toys” as the agent of change

8. TYPES OF PLAY • Connecting play – literal contact with toys • Safe play – child is in control of toys or therapist • Unsafe play – uncontrolled expression • Resolution play – child finds a way to cope with or contain unsafe play

9. Exploratory/Sensorimotor Relational Play Constructive Play Dramatic Play (Symbolic) Games – with – Rules - Play 0 – 24 months 9 – 24 months 24 + months 21 – 72 months 60 months + DEVELOPMENTAL STAGES OF PLAY

10. RECOGNIZING THE SIGNS OF CHILDHOOD PROBLEMS • Prolonged and intense discomfort • Problem affects other areas of development • Problem spreads to other areas of child’s life • Family is affected by the problem

11. Power/Control Anger/Sadness Trust/Relationships/ Abandonment Nurturing/Rejection/Security Boundaries/ Intrusion Violation/Protection Self-Esteem/Self Worth/ Empowerment Fears/Anxiety Loyalty/Betrayal Loss/Death Adjustment/Change COMMON THEMES IN CHILDREN’S PLAY (cont)

12. FEATURES OF POSTTRAUMATIC PLAY • Compulsive Repetition • Unconscious Link Between Play and Event • Literal Play – with simple defenses • Failure to Relieve Anxiety • Resistant to Interpretations

13. FEATURES OF POSTTRAUMATIC PLAY (cont) • Devoid of enjoyment or expression • Often occurs in Secret (L. Terr, 1983)

14. EFFICACY OF PLAY THERAPY Meta-Analysis of 94 research studies involving over 4,000 subjects determined: • A large and positive effect of treatment outcomes with children • Play Therapy appeared effective across modality, age, gender and clinical vs. nonclinical populations • Effects were greatest when there was parent involvement in treatment • Duration of sessions was monitored: Optimal effectiveness continued up to 35/45 sessions, yet brief sessions also held positive effects for certain issues. (Ray, Bratton, Rhine & Jones, 2001)

15. EFFICACY OF PLAY THERAPY(cont) Play therapy has been widely researched: World of Play Therapy Literature Review references 2,300 related studies (University of North Texas; Centre for Play Therapy, 2000)

16. ROLE OF PLAY THERAPIST • Establish Safety & Therapeutic Relationship • Accept child exactly as she / he is • Track the child’s interests, use of play objects, affect and verbalization • Recognize the child’s ability to solve problems through the play therapy relationship • Listen & attend communicate & reflect • Set limits necessary to anchor the therapy to reality and raise child’s awareness of his / her responsibility to the relationship • Include parents and establish their role.

17. Play Therapy “Schools” and Theories

18. COMMONALITIES ACROSS MODELS Recognition of major therapeutic powers of play • Communication power • Teaching power • Ego-boosting power • Self-actualization • Corrective power Schaefer, 2003

19. CHILD CLIENT ENDS THE DEBATE Directive or Nondirective, what does the child need?

20. EXPERIENTIAL ACTIVITY

21. Play capacity Ability to communicate Developmental stage Emotional capacity Self-regulation ability Yasenik & Gardner (2004) Attachment organization World view: Cognitive schema Defense mechanisms Resilience Support network CHILD MODERATING FACTORS

22. PLAY THERAPY DIMENSIONS MODEL Consciousness Dimension: • Reflects the child’s representation of consciousness in play • Indicated by child’s play activities and verbalizations • Weaving process- consciousness varies with child’s need for distance and protection Yasenik & Gardner (2004)

23. PLAY THERAPY DIMENSIONS MODEL Directiveness Dimension: • Degree of immersion and interpretation by Play Therapist • Weaving process- moving from tracking play to entering the play as a co-facilitator Yasenik & Gardner (2004)

24. THE 4 QUADRANTS • Quadrant I: Active Utilization • Quadrant II: Open Discussion and Exploration • Quadrant III: Non-Intrusive Responding • Quadrant IV: Co-facilitation Yasenik & Gardner (2004)

25. ILLUSTRATIVE CASE EXAMPLE • DVD case example of “Ellis”

26. EXPLORE QUADRANT III: GROUP ACTIVITY Indications for working in this quadrant: • Therapeutic process • Responses of the child • Child’s play capacity • Child’s drive and direction in therapy • Context of the presenting issue • Time-lines and system parameters Yasenik & Gardner (2004)

27. EXPERIENTIAL EXERCISE- QUADRANT III-IV • Work in partners • Choose some miniatures • Role play: Start in Quad III- Non-Intrusive Responding and look for opportunities to elaborate the play (while remaining in the child’s metaphor). Yasenik & Gardner (2004)

28. DEBRIEFING EXERCISE Stay in your pairs and answer the following: • Therapist - What was your comfort level re: becoming more directive? • What was the child’s response? • What was your entry point and how did you make use of yourself? • Child- How intrusive was the therapist and did they elaborate the play? Yasenik & Gardner (2004)

29. CASE CONCEPTUALIZATION: DECISION MAKING Participant case example • Answering important questions… Where do I start? What are the goals? What is the next step? Appendix A- Play Therapy Dimensions Decision-Making Guide exercise Yasenik & Gardner (2004)

30. QUESTIONS

31. PRACTICAL GOAL SETTING • Goals identified by the child • Goals identified by the parent • Goals identified by the therapist (review and interpretation of data & observations • Child’s overall functioning (cognitive, emotional, and social functioning)

32. PROVIDING FEEDBACK TO PARENTS • Parents need feedback throughout the entire process • Reflect the feelings of parents • Provide parents with a practical focus while the therapy work is happening • Normalize wherever possible