Innovations in Play Therapy

Garry L. Landreth

• Publisher: Routledge
• Year: 2013
• ISBN:
  9781135058012
• Edition: 1
• Topic: Psychologie
• Subtopic: Psychothérapie

This book is unique in exploring the process of conducting short-term intensive group play therapy and the subsequent results. It focuses on play therapy with special populations of aggressive acting-out children, autistic children, chronically ill children, traumatized children, selective mute children, disassociative identity disorder adults with child alters, and the elderly.

The book addresses such vital issues as:

* How play therapy helps children

* Confidentiality in working with children

* How to work with parents

* What the play therapist needs to know about medications for children

The difficult dimension of diagnosis is clarified through specific descriptions of how the play therapist can use play behaviors to diagnose physical abuse, sexual abuse, and emotional maladjustment in children.

PART IV

PLAY THERAPY WITH SPECIAL POPULATIONS

15

Play Therapy with Aggressive Acting-Out Children

SHAUNDA PETERSON JOHNSON PATRICIA CHUCK

I n recent years, one of the most common referrals of children to mental health services is for aggressive and acting-out behaviors. Often, these be haviors are displayed in the classroom, serving as sources of constant disruption, as well as danger toward others. With juvenile crime on the rise, there is a great need for screening and intervention with children at an early age. In addition, professionals and clinicians in the field must be educated in how to understand and best work with the aggressive child. This chapter presents an overview of the following: (a) aggressive acting-out children’s needs and behaviors, (b) rationale for the use of play therapy with this population, (c) aggressive behaviors exhibited in the playroom, (d) limit setting, (e) play materials utilized for the expression of aggression, (f) stages during the therapeutic process, (g) and case studies that provide documented effectiveness of play therapy with aggressive acting-out children.

AGGRESSIVE ACTING-OUT CHILDREN

A child who engages in aggressive, acting-out behavior may be using the aggression as a shield to protect against feeling unwanted, unimportant, unloved, or unlovable. An aggressive child may feel incapable of attracting the genuine interest or caring of others and therefore, may initially reject the play therapist as a way to protect himself. At such times, it is important that the play therapist remain sensitive to and focused on the child’s feelings about himself. The child’s acting-out behavior is not a personal reaction to the therapist.

At an early age, aggressive children have commonly experienced some type of injury to the self involving the parents, such as a serious disappointment in the family, loss of a sense of safety or protection, abuse or neglect, loss of attention from a parent because of a divorce, parental depression, or birth of a sibling. The child may remain fixated at the developmental level in which the traumatic event occurred, experiencing difficulty differentiating various degrees of threat to the self. A fragile self-concept tends to leave the child constantly on guard to defend against criticism or perceived attacks by others. The child’s lack of connectedness with others and a negative self-concept often create a “narcissistic vulnerability” (Willock, 1983, p. 389) in the child’s personality. Tied to this sense of vulnerability are feelings of anger, depression, and distress that the child defends against by developing a callous attitude and engaging in distinctly antisocial behaviors.

Aggressive acting-out children depend on their self-protection mechanisms to provide themselves with a sense of security that they are lacking. For these children, aggression often becomes the child’s most reliable defense for coping with the world. Feeling threatened by the intimacy of a therapeutic relationship, the child will more than likely be skeptical and resistant to a therapist who is perceived as trying to change the child’s behavior. The child may feel suspicious of any question or comment made by the therapist. Furthermore, difficulties might arise based on the therapist’s reaction to the child’s aggression. Many play therapists experience difficulty in appropriately responding to a child who directs physical aggression toward them.

RATIONALE FOR USING PLAY THERAPY WITH AGGRESSIVE ACTING-OUT CHILDREN

Aggressive, acting-out children are notably one of the most difficult populations that play therapists encounter (Willock, 1983). However, play therapy is well suited to meet the needs of aggressive children (Landreth, Homeyer, Glover, & Sweeney, 1996). Play is a child’s most natural means of self-expression and is an essential component of childhood development (Landreth, 1991). Through play a child is able to release pent-up feelings of anxiety, disappointment, fear, aggression, insecurity, and confusion. Bringing these feelings to the surface encourages the child to deal with them, learn to master them, or abandon them (Axline, 1969). Through symbolic representation, the child gains a sense of control over events that seem uncontrollable in reality. Often, children are unable to verbally express what they are feeling; thus, in play therapy toys serve as children’s words and play serves as their language. Toys are used by children to express thoughts, feelings, and actions that the child is unable to express in reality (Landreth, 1991). An aggressive acting-out child uses play as a language for expressing negative feelings.

An inability to express emotions, especially those emotions connected to traumatic events, has been linked to aggressive acting-out behaviors (Ginsberg, 1993). When a child is able to release and express strong negative emotions, and remains accepted by the therapist, the emotions lose some of their intensity and the child experiences less disturbance (Moustakas, 1953). The playroom provides a safe place for a child to release these feelings and to reenact experiences. Within a nonthreatening therapeutic environment, the child is free to express and explore inner thoughts, feelings, experiences, and behaviors. The release of aggression allows the child to reduce inner frustration. Being able to release or express the emotion has a cathartic effect and allows the child to move beyond maladaptive behaviors to a more effective way of functioning. The symbolic nature of play allows children to transfer strong feelings, such as anger, fear, anxiety, guilt, or frustration, onto toy objects instead of real people. Children are protected from their own strong actions and emotions connected to traumatic experiences because their feelings are acted out in fantasy rather than reality (Landreth, 1993a).

In responding to an aggressive acting-out child in play therapy, the therapist should strive to meet the child’s inner needs underlying the behavior. The focus of play therapy is to gain an understanding of the child, not to merely stop the undesired behavior (Landreth et al., 1996). When the therapist relates to the child with genuine acceptance and respect, this sends a message that the child is a worthwhile individual. The therapeutic relationship is then used as a testing ground for the child to build self-esteem and explore more constructive ways of dealing with the environment. With aggressive children, the play therapist must consistently strive to identify with their internal frame of reference in order to understand their external reactions to the world. “Once the feelings and needs behind aggressive acts have been accepted and allowed to be expressed, children are able to go on to explore more positive behaviors” (Landreth et al., 1996, p. 15).

A typical concern surrounding the expression of aggressive, acting-out behavior in the playroom is whether the child will continue these socially unacceptable behaviors outside of the playroom. Dorfman (1958) proposed several answers to these concerns. First, children in play therapy are neither praised for specific behaviors nor encouraged for particular verbalizations or actions. Because of this, children develop an awareness that they are responsible for their own behavior. Second, children recognize that being in the playroom is unlike daily life. Third, simply restricting certain behaviors outside of the playroom does not eliminate the child’s need for that behavior. The therapist’s acceptance of the total child, despite any problems, allows the child the freedom to expose inner emotions. In order to be certain of the therapist’s acceptance, the child may test the therapist by demonstrating parts of his or her personality which are frequently rejected. Fourth, the therapist’s acceptance of the child appears to decrease aggressive behavior, rather than increase aggressive behavior. Finally, the playroom is not a place of complete freedom. The therapist carefully sets limits and boundaries around the child’s inappropriate behavior.

LIMIT SETTING WITH AGGRESSIVE ACTING-OUT CHILDREN

Limit setting is an area of particular concern when working with aggressive acting-out children. The physical safety of the child, therapist, and the playroom must be protected through appropriate limit setting. Through setting limits, the therapist is able to preserve feelings of acceptance, empathy, and positive regard for the aggressive acting-out child. It would be virtually impossible for the therapist to remain warm, empathetic, and accepting of a child who attacks the therapist causing physical pain or discomfort. The therapist would have difficulty accepting a child who is allowed to pull the therapist’s hair, paint his face, rip his clothes, or destroy his glasses (Ginott, 1994). Undoubtedly some type of anger or resentment would surface in the therapist that could be interpreted by the child as rejection.

Therapists should not allow the child’s actions to push them beyond a level that can be tolerated, thereby inhibiting positive acceptance of the child. However, it is imperative that the therapist be able to demonstrate a certain degree of tolerance, and that the therapist’s personal needs do not interfere with the child’s need to be messy or destructive (Landreth, 1991). “The therapist must be able to accept the hypothesis that the child has reasons for what he does and that many things may be important to the child that he is not able to communicate to the therapist” (Axline, 1955, p. 623).

Preventing the child from physically harming the therapist or destroying toys by setting limits helps the child develop a sense of security and consistency in the child-therapist relationship (Axline, 1955). “Children do not feel safe, valued, or accepted in a completely permissive relationship” (Landreth, 1993a, p. 23). A goal of limit setting is to promote the child’s release of aggression through symbolic expression, rather than direct acting-out. For example, a child who is angry at his mother can punch, stab, or shoot a doll that symbolically represents the child’s mother (Ginott, 1994). When children are able to symbolically express their negative feelings, they are freed from potential anxiety or guilt over actually harming someone or something.

It is important to note that while the therapist limits the child’s undesirable behavior, the therapist allows the child to express feelings through verbal and play outlets. Limits help strengthen the child’s self-control as the child learns to differentiate between desires and actions. Whereas all feelings are accepted, the child learns that feelings may not always be acted on in any chosen manner. “By accepting the child’s feelings and preventing his undesirable acts, the therapist reduces the child’s guilt and at the same time turns his wishes in the direction of reality controls” (Ginott, 1994, p. 105).

Bixler (1949) maintained that the foundation for working with aggressive children lies in a strict adherence to limits on behavior in conjunction with an acceptance of the child’s feelings that motivate the behavior. Moreover, Landreth (1991) has consistently maintained that the child’s need to violate a limit is of greater therapeutic value than the child’s actual behavior. Within the therapeutic relationship, it is of critical importance that the therapist continually seek an understanding of the meaning of the aggressive behavior to each individual child. When limits are necessary, Landreth’s (1991, p. 223) ACT model of therapeutic limit setting is recommended.

A—Acknowledge the child’s feelings, wishes, and wants.

C—Communicate the limit.

T—Target acceptable alternatives.

AGGRESSIVE BEHAVIORS IN THE PLAYROOM

Aggressive acting-out children present the play therapist with quite a challenge. In addition to an awareness of the therapeutic relationship, therapists must be conscious of protecting themselves, the child, and the playroom. It is not unlikely that an aggressive child would choose to destroy the playroom before the child would choose to talk about feelings (Willock, 1983). During the initial play therapy sessions, the emotions of distressed children are most often diffuse and undifferentiated. Negative feelings are typically expressed by these children (Moustakas, 1953).

Attitudes of hostility, anxiety, and regression are pervasive in their expression in the playroom. Children are frightened, angry, or immature without definitely focusing their feelings on any particular person or persons or emotional experiences. They are often afraid of almost everything and everybody and sometimes feel like destroying all people, or merely wish they would be left completely alone, or wish to regress to a simpler, less demanding level of adjustment. (Moustakas, 1953, p. 7)

Therapists must be prepared to encounter a variety of aggressive acts, including biting, spitting, kicking, hitting, obscenities, or flying toys (Willock, 1983). O’Connor (1986) identified the following as hostile behaviors in the play room: yelling, shooting the dart gun, striking an object, throwing objects, acting out others’ deaths, discussing hurting someone or revenge, demanding the therapist perform some behavior, and discussing the child’s own misbehavior that resulted in punishment. Anger might be expressed by the child through attempts to beat, smash, destroy, rip, or crush the materials in the playroom (Moustakas, 1953). Initially, the child’s actions may appear to be random and without purpose. However, Moustakas (1953) maintained that as the child experiences greater trust and acceptance from the therapist, the child’s anger will appear more focused. As the therapeutic relationship develops, expressions of aggression become less diffuse and are more directly connected to a specific person or experience. As the child releases negative feelings, the feelings become less severe and as a result are easier for the child to manage. Willock (1983) proposed that it is the therapist’s constant striving to understand the meaning behind the child’s aggressive, acting-out behavior that maintains a therapeutic environment in the midst of the seeming chaos.

PLAY MATERIALS

“Shooting, burying, biting, hitting, and stabbing are acceptable in the playroom because they are expressed symbolically” on toys (Landreth, 1991, p. 122). A wide variety of play materials can be utilized to facilitate the child’s expression or symbolic representation of aggression, frustration, or hostility. Landreth (1993b) suggested the following toys as appropriate for acting-out or release of aggression: a bop bag, a rubber knife, guns, toy soldiers, and an alligator puppet. The alligator puppet is selected because it can be used to act out aggressive acts such as chomping, biting, or crunching. Landreth (1993b) also suggested less structured items such as a clay, blocks, sand, and puppets or dolls.

Clay is both a creative and an aggressive play material because a child can pound, mash, roll out, and pull apart the clay with great passion and intensity. Blocks can also be used as a creative material for constructively building something, as well as a tool for releasing aggression through destruction by knocking over or kicking down the blocks. Sand provides an outlet for aggression by providing the child with a place to bury dolls and other toys. Puppets and dolls can be used by children to symbolically represent their family, thus helping children express experiences with sibling rivalry, family conflicts, anger, fear, frustration, and violence. Puppets and dolls can serve as a buffer between the child’s fantasy play and reality (Landreth, 1993b). In addition to the previously mentioned play materials, playrooms should include inexpensive items, such as egg cartons or popsicle sticks that can be broken, smashed, or thrown by the child. According to Landreth (1991), every play therapy experience should have some item that can be destroyed, such as egg cartons. Bursting balloons, tearing newspaper, and wadding paper can also facilitate the expression of emotions that accompany aggression.

TOOLS FOR SYMBOLIC EXPRESSION OF AGGRESSION IN THE PLAYROOM

A wide variety of...

Table of contents

• Cover Page
• Half Title page
• Title Page
• Copyright Page
• Contents
• About the Editor
• Contributors
• Preface
• Special Considerations For the Role of the Play Therapist
• Facilitative Dimensions of Play in the Play Therapy Process
• Essential Personality Characteristics of Effective Play Therepists
• Cultural Considerations in Play Therapy
• Play Therapy with Chinese Children Needed Modifications
• What the Play Therapist Needs to Know about Medications
• Legal and Ethical Issues in Play Therapy
• The Parents Part in the Play Therapy Process
• Clinical Innovations in Play as a Diagnostic Tool
• Play Therapy Behaviors of Physically Abused Children
• Play Therapy Behaviors of Sexually Abused Children
• Identifying Sexually Abused Children in Play Therapy
• Diagnostic Assessment of Children's Play Therapy Behavior
• Innovative Procedures in Play Therapy
• Child-Centered Group Play Therapy
• Intensive Short-Term Group Play Therapy
• Short-Term Play Therapy
• Play Therapy with Special Populations
• Play Therapy with Aggressive Acting-Out Children
• Play Therapy with Autistic Children
• Play Therapy for Children with Chronic Illness
• Play Therapy with Traumatized Children A Crisis Response
• Play Therapy with Selective Mute Children
• Play Therapy with Dissociative Identity Disorder Clients with Child Alters
• Play Therapy with the Elderly
• Have Toys—Will Travel A Traveling Play Therapist in the School Setting
• Index