Challenges in the Theory and Practice of Play Therapy

David Le Vay, Elise Cuschieri, David Le Vay, Elise Cuschieri

• Publisher: Routledge
• Year: 2016
• ISBN:
  9781317378976
• Edition: 1
• Topic: Psychology
• Subtopic: Psychotherapy
• Index: Psychology

Challenges in the Theory and Practice of Play Therapy provides an advanced and in-depth exploration of the issues and challenges relating to the training, theory and practice of Child-Centred Play Therapy. The ethos of the book is process orientated, and it discusses the particular therapeutic challenges that are encountered on a day-to- day basis.

Drawing upon clinical material and cutting-edge theory, David Le Vay and Elise Cuschieri bring together experienced practitioners from the field to explore key topics such as:

• The therapeutic use of self within play therapy

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• Gender issues in play therapy

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• The play therapist's experience of self-doubt

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• Working with acquired brain injury

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• Working with developmental trauma

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• The role of research within play therapy

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• The role of experiential training groups in a play therapy training programme

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Original and stimulating, Challenges in the Theory and Practice of Play Therapy will be of interest and value to all those working within the area of child mental health, both in practice and in training, and particularly those in the wider Arts and Play Therapy community who are working therapeutically with troubled children.

Chapter 1
To be or not to be?

The therapeutic use of self within child-centred play therapy

David Le Vay

The Rogerian principle of congruence is rightly understood as being a fundamental core condition of the play therapy process. Similarly, we talk about the concepts of genuineness and authenticity in our practice, indeed not simply concepts but ways of being that lie at the very heart of what it means to be a child-centred play therapist. But experience suggests that many play therapists still grapple with the idea of what it means to be truly congruent and whether to hold such a position is ever really viable or indeed desirable and hence the therapist filter that we seek to apply as a way of managing the complex relational ebb and flow between self and other. Clearly, the nature of this personal filter is shaped by experience, training and developing self-awareness: the learned intuitive state of unconscious competence perhaps, as well as the particular, unique quality of the therapeutic relationship.

The Rogerian approach holds that the personhood of the therapist is the central element of the change process; but what do we mean by personhood, and how does this relate to the therapeutic use of self? Certainly, there are degrees of personal transparency and opaqueness, the extent to which we make ourselves truly present and visible to the child, but transparency is not the same as congruence, just as congruence is not the same as self-disclosure or indeed personhood as the use of self. The relationship between these concepts often seems complex and unclear, assumed perhaps rather than understood. So what do we mean by use of self and how does this inform the desired attitudinal states of congruency and authenticity? How, as therapists, do we make decisions about self-disclosure and what we choose to share or withhold? In this chapter I aim to explore some of these perennial questions and practice challenges faced by the play therapist, the extent to which we bring ourselves into the work that we do and, ultimately, into our relationships with the children that we are working with therapeutically.

In terms of personal process, I have experienced writing this chapter as something of a challenge, the concept of the use of self within child-centred play therapy (CCPT) being complex and hard to unravel. As play therapists, we talk liberally about notions of congruence, authenticity, genuineness and transparency, all of which contribute to that which we might generically refer to as the use of self. Along with empathy and unconditional positive regard (UPR), these are understood as being the essential, attitudinal pre-conditions of CCPT, conditions that need to be both felt internally and expressed externally in order to facilitate a positive therapeutic experience for the child. But there is an intangible, subjective and ultimately indefinable quality to these therapeutic conditions that does not easily lend itself to a process of measurement or evaluation. So in an attempt to untangle some of these conceptual knots, I will begin by seeking some understanding of the term use of self and then look at the notions of personhood, congruence and self-disclosure as they might apply to play therapy before going on to explore some of the more specific practice issues that invariably arise as we bring ourselves into our work with children. Throughout this chapter I will be drawing upon brief clinical vignettes from my practice, identifying details from which have been disguised and anonymised in order to maintain confidentiality.

Use of self

There are, I would suggest, connections between the use of self and the feelings of therapist competence and self-doubt that have been discussed elsewhere in this book and how confident we are in the personal and professional identity of ourselves as therapists. To use ourselves in our work, to use the self as an agent of change, requires by definition a confidence and knowledge in who we are. As Rogers said, “to be a fully authentic therapist … you have to feel entirely secure as a person. This allows you to let go of yourself, knowing confidently that you can come back” (Baldwin, 2000: 36). But sometimes perhaps we lose our way, lose sight of our professional identity as a therapist or become pulled out of shape by either the clinical, interrelationship dynamics of the therapy itself or perhaps by external events that impact who and how we are in the playroom at any given moment. Indeed, what is it that either empowers or disempowers our capacity to let go and find our way back?

The pathway is not always clearly signposted, the route not always apparent. Yes, we have markers along the way, weathered cairns of knowledge, experience and training. Sometimes eroded by familiarity, these metaphorical stone markers give a contextual sense of the landscape and the shape and contours of the surrounding environment, a relief map one might say. But often as therapists it is in the absence of such markers that we are required to have faith in the process and to trust that we are heading in the right direction, and how we use ourselves and bring our own self-awareness into the therapeutic relationship is ultimately the most important and uniquely significant element of this process. As Landreth (1991: 65) says, it is about being real – a “living out of the self in the moment of the relationship” – but for both trainees and experienced therapists the challenge is often in knowing how real to be. To be or not to be? For trainee play therapists especially this question can evoke some powerfully conflictual and often paralysing responses as they begin to feel their way through the uncharted territory of the therapeutic process. After all, there are some inherently paradoxical tensions between the juxtaposed positions of authenticity and self-withholding that tend to be communicated to trainees. In a sense, the ambiguous message conveyed is ‘to be but don’t be’ – something of an existential double bind, one might suggest.

But it strikes me that the term use of self is something of a misnomer in the context of CCPT. It is perhaps not so much about how we use ourselves in our work, the suggestion being of some kind of conscious, active application of the self as a therapeutic tool, but more an acknowledgment that our personhood, our very presence, pervades, permeates and diffuses through the therapeutic relationship at all times, for better or worse. As the saying goes, ‘wherever I go, there I am’, and the notion that we can leave ourselves outside the playroom and enter the session “without memory or desire” (Bion, 1970) just as we might hang up our coat is, I would suggest, more of an aspiration than a reality.

Lanyado (2004) talks about the presence of the therapist, and in many ways this is a more helpful way to think about the use of self, the emphasis more upon being than doing as we consider the dynamic, interpersonal nature of the relationship between ourselves and our clients. As Lanyado suggests, it is perhaps easier for us as therapists to think about what does not (or should not) come into the therapy room with us than to think about what actually does. Clearly, we all endeavour to put aside whatever personal issues, opinions, thoughts, feelings, attitudes that we might be experiencing prior to entering the playroom with a child, to hit the internal ‘restore to factory settings’ switch that helps us to re-set ourselves between sessions. To think about what we bring in with us, that which slips under the radar of our personal consciousness, inevitably requires us to acknowledge our fallibilities, our growing edges, our blind spots: those aspects of ourselves of which we may not be so consciously aware but nevertheless seep osmotically across the therapeutic boundary between self and other. As Lanyado says, “the need for the therapist to continue to scrutinise his or her inner world, to sift the impact of the (child) from the background noise of the therapist’s personal domain, remains throughout the therapist’s working life” (2004: 4).

So perhaps it is not so much what we should leave by the door but an awareness of what it is we are actually taking through with us. Let us not aspire to hanging up our identity along with our hat and coat but acknowledge and accept who we are and the unique quality this brings to the therapeutic process. We cannot separate self and other, nor should we, and the conceptual frame of the opaque, analytical mirror does not sit comfortably with CCPT. If play therapy is about a way of being and all that this entails, then we cannot deny who we are and need to accept that we are all unique individuals who will work in our own unique, individual way. Sometimes this means taking risks; as Landreth suggests, “allowing one’s self to be vulnerable enough to be impacted or touched emotionally by the child’s experiences and feelings requires personal courage and an openness to risk sharing self in a very personal way that is non-defensive” (Landreth, 1991: 92). This does not mean a sharing of self in the form of self-disclosure but in the sense of having sufficient self-awareness and understanding to allow us to respond intuitively to the child’s creative and expressive communication. This requires being open to our vulnerabilities, our mistakes and misjudgements (as well, of course, as our strengths) and whilst we all clearly aspire to being as good a therapist as we can, we also have to accept that the process of learning never stops – and if it does it is perhaps time to stop being a therapist. Being human is a developmental experience, as is being a therapist, and I strongly eschew ideas of perfection or expertise. Once someone has declared themselves an expert, I would suggest they have little left to learn, and that is a position I would personally view with some caution.

The personhood of the play therapist: Congruence and authenticity

Personhood within a child-centred play therapy context can be thought about as the very essence of what it means to be fully present in the playroom. It is about being congruent, authentic and genuine and at all times open to the immediacy of our feelings and experiences. It is also about recognising and accepting who we are, the individual and unique set of qualities, traits and characteristics that make up our self and how these become manifest within the relationship with the child. Landreth talks about the quality of being there for the child – “the play therapist knows that being present with the child requires much more than a physical presence; that being there is truly an art form that makes the play therapy experience unique for the child” (1991: 90). Personhood then is about therapeutic presence, about being there in body, in thought and in feeling; an overarching expression of self and experience that encompasses and communicates the core conditions of child-centred play therapy: congruence, empathy and unconditional positive regard.

For the purposes of this discussion, I will focus mainly upon the core condition of congruence, the expression of self or personhood that connects most strongly to our sense of therapeutic presence in the playroom. Clearly, empathy and UPR are themselves expressions of congruence; they are all part of the felt, attitudinal way of being spoken of earlier, and it is hard to disentangle one from the other; congruence being the means through which empathy and UPR are conveyed. By way of defining congruence, Rogers says:

Whatever feeling or attitude I am experiencing would be matched by my awareness of that attitude. When this is true, then I am a unified or integrated person in that moment, and hence I can be whatever I deeply am … when self-experiences are accurately symbolised, and are included in the self-concept in this accurately symbolised form, then the state is one of congruence of self and experience.

(1959: 206)

A state of congruence then would suggest that the therapist’s external expressions of self are matched or in harmony with their felt, internal experience, an integration of thought, awareness and affect that together create a sense of authenticity. Of course, this does not mean that every thought or feeling is communicated explicitly to the child. At various times we might experience feelings of irritation, boredom, anger, rejection or excitement, but to express these feelings indiscriminately to the child would clearly be both inappropriate and irresponsible (and certainly not therapeutic), and in this sense the distinction between transparency and congruence can begin to be made. As Means and Thorne (2000) have cautioned, congruence should not be viewed as an invitation for the play therapist to communicate to the child any and every thought or feeling that may arise. Congruence then is not about allowing the child to know or see all of one’s internal process but instead to have sufficient self-awareness and insight and understanding to know what should be expressed or withheld, child directed or self directed, with the aim being always to enhance the therapeutic relationship. Realness is “being aware of and accepting one’s own feelings and reactions with insight into the accompanying motivation and being willing to be oneself and to express these feelings and reactions when appropriate” (Landreth, 1991: 65).

Being self-aware also requires us to reflect upon how we communicate on a non-verbal, bodily level. Irritation with a child can be communicated through a momentary look in the eye, a furtive glance at the clock, tone of voice or posture and movement. Congruence, then, is communicated both verbally and non-verbally and is ultimately the felt, authentic experience of being in the presence of another. The children that we work with, especially children who have experienced trauma and abuse, are intuitively, vigilantly aware of body language and non-verbal communication; it is after all a part of their protective coping strategies, and I would suggest that most children have an instinctive sense of the extent to which an adult is being authentic or otherwise. The façade or mask of incongruence, wherein there is a divergence or discrepancy between the internal experience of the therapist and the externally communicated self will, I suggest, be all too apparent to the child in the playroom.

The significance of non-verbal communication should not be under-estimated. Barrett-Lennard (1962), who developed the Relationship Inventory (BLRI) as a means of assessing the core conditions of person-centred therapy, found that whilst congruent therapists are more honest, direct and sincere in their communications than are therapists of other theoretical disciplines, incongruence is “most often demonstrated through inconsistencies between what therapists say and what they imply through gestures, expressions or tone of voice and through indications of anxiety, discomfort or tension” (Ray, Jayne and Stulmaker, 2014: 19). Emphasising this point, Van Fleet, Sywulak, Sniscak and Guerney (2010) stated that a key element of the attitudinal state of congruence is the consistency among body language, intonation and the spoken words of the therapist. In this sense, it is as much about how we communicate as it is about what we are communicating.

Of course congruence, genuineness or authenticity as a desired state of being with a child is not always easy or comfortable. At times we may feel deeply conflicted or feel challenged by the child who tests the boundaries of therapy and pushes at our personal limits of acceptance. Some children we may naturally warm to, others less so. Some will evoke powerful feelings of rage, disgust or idealisation. There is a visceral vitality and directness to working with children therapeutically, communicated through the dynamic quality of their dramatic play, and to truly be with a child means by definition to open oneself up to the powerful and often intense projective and transferential material that is so much a part of the therapeutic relationship. During the course of my work with very traumatised children I can recall many times that feeling of anxious anticipation as I awaited the tellingly urgent ring of the clinic’s doorbell, knowing that it was going to be another long, hard session that would test my capacity to emotionally contain the child. Is it always possible to be truly congruent? Certainly, there have been times when I have been aware of my own façade, the act of projecting an external sense of containing calmness and acceptance when internally I have been working hard to manage my own anxiety. At times like these one needs to be self-aware enough to monitor these feelings of incongruity, accept them and ensure that they don’t intrude upon the therapeutic process. A little self-talk or the faithful internal supervisor is always helpful at these moments. A state of congruence then perhaps needs to be viewed as an aspiration, a therapeutic way of being that we would all strive for in our work with children whilst recognising that there are times when this does not always feel attainable. As Ray, Jayne and Stulmaker (2014) suggest, congruence is experienced as a flow within the relationship between self and other – between play therapist and child, a continuum along which the therapist endeavours to reach an optimum state of authenticity.

Self-disclosure

I recall once working with a young adolescent, I’ll call him Shane, who had experienced a catalogue of trauma and abuse throughout his childhood. Perched precariously on the edge of his chair, coat tightly wrapped around him and hood pulled down over his eyes, this was a young person deeply affected by intense feelings of anxiety, mistrust and shame. Our first session together was pervaded by his deeply withholding silence, broken only by the uncomfortable sound of him methodically cracking his knuckles. I remember feeling quite helpless in the face of his intense anxiety, my words feeling like bullets that could pierce his fragile, protective shell. His threat responses were highly aroused, his body tensed in readiness to either fight or run. Conscious of not wanting to allow my own anxiety to drive my responses, I simply reflected upon what was happening in the present; the sound of his cracking knuckles, how this made me feel physically and wondering aloud about whether his actions might hurt or harm him.

From under his hood and baseball cap, Shane told me that he did not feel pain – that nothing ever hurt him – and he went on to crack the joints of his wrists, ankles and even neck, clearly enjoying my own rather pained, winced responses to his bone-cracking exploits. Somehow, we started talking about escapologists and the notion of being double-jointed, which led us further into a conversation about the numerous accidents and injuries Shane had experienced over the years. Metaphorically, the sub-text to this exchange seemed to be about his experience of developmental trauma, the feelings being held and communicated on a bodily level, letting me know how much in fact he had been hurt despite his claim to be impervious to pain. He then showed me various scars on his legs and arms that had been caused by all manner of jumping, climbing and falling over the course of his childhood. I had some small scars and marks on my lower arm, and for some reason I found myself showing these to Shane, and together we joked about the scene from the film Jaws in which Richard Dreyfuss and Robert Shaw compared...

Table of contents

• Cover
• Title
• Copyright
• Contents
• Foreword
• Preface
• 1 To be or not to be? The therapeutic use of self within child-centred play therapy
• 2 Can I really do this? An exploration into therapist self-doubt
• 3 Reflections on gender: The male play therapist
• 4 Bridging the cultural divide: Meeting cultural challenges with enhanced awareness, knowledge and skills
• 5 Stuck in the dollhouse: A brain-based perspective of post-traumatic play
• 6 Who am I now? How play therapy can empower children and adolescents in their ‘search for self’ following severe acquired brain injury
• 7 Tackling taboos: Research in play therapy
• 8 The role of the process group within a play therapy training programme: A conversation
• Contributor biographies
• Index