CALl FORNI A STATE UNI VERSITY, NORTHR I DGE
CRI T IQUE OF L I TERATURE
ON
PLAY THERAPY
A project submi tted i n partial satisfaction of the
requirements for the degree of Master of Arts i n
Educati onal Psychology
by
Pamela Ann Phi l l ips
January 1 986
The Proj ect of Pamel a Ann Phi l l i ps 1s approved:
-
Stan Charnofsky, Plt!l:
Eugenfi G i gl i o, P�.
r
Bernard N1senho l z, Ph.D., Chai r
(
Cal i forn i a State Universi ty, Northridge
ii
TABLE OF CONTENTS
Page
ABSTRACT
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iv
Chapter
I.
I NTRODUCT ION
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Statem ent of the Probl em
Purpose of the Study
Definitions of Terms
Questi ons
S i gn i fi cance of the Study
Sources of Materia 1s
Procedures for Col l ection of Data
I I.
THEORI STS AND THE I R APPROACHES
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Psychoana 1yt i c Approach
Structured Approach
Re1 at i onsh i p Approach
Nondirective Approach
L i m i t-Setti ng Approach
Summary
I l l.
RESEARCH RELEVANT TO MAJOR APPROACHES
.
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41
Studi es Using Psychoanalyti c Theory
Studi es Using Structured Theory
Stud i es Using Relat i onsh i p Theory
Studi es Using Nondirective Theory
Studi es Using L i m i t-Setting Theory
Summary
I V.
SUMMARY AND CONCLUSI ONS
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60
Summary
Cone 1 us ions
BI BL IOGRAPHY
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iii
ABSTRACT
CRI T I QUE OF L ITERATURE
ON
PLAY THERAPY
by
Pamela Ann Phi l l i ps
Master of Arts i n Educati onal Psychol ogy
L iterature i n the area of p l ay therapy was surveyed, summar1zed,
and organi zed. The h1storical approach was used i n the col l ection of data
for this study. Materials were gathered through l ibrary services and
therapi sts i n the fi eld. The material found was divided i nto theory,
approach, and research. Theory and approach were organi zed i nto Chapter
I I . Material on research was organi zed i nto Chapter I ll.
After an extensive search of the l iterature, i t w as found that materi al
iv
was scattered throughout books and j ournal s. Much of the hterature dealt
w i th ei ther theory or practice or both, but did not i nclude research. I f
research was presented, i t was often not accompanied by theory.
This study provi des a summary of the theory behind each of the major
psychodynami c approaches, and discusses the theory and approach of the
major theorists pub l i shed i n each area. A thorough revi ew and summary of
the research found rel at i ng to the major theories is presented.
A summary and conclusions, i ncluding research needs on outcome and
process, are i nc luded i n Chapter I V. An extensive b i b l iography i s
presented a t the end to aide the professional , the student, and the
researcher i n using this study as an i mportant reference source.
v
Chapter 1
I NTROOUCT ION
P l ay therapy has been described as the opportuni ty by which a chi l d can
experience growth by using his most natural medium of expression, play
(Ax l l ne, 1 947b). Even as early as Ari stotl e, pl ay was bel i eved to have i ts
beneficial uses. He bel l eved that p l ay w as an emotional outl et for
anxieties (Mi tchel l , 1 948). I n the writings of Rousseau, it can be found
that he bel i eved p l ay to be helpful in understandi ng and educating chi ldren.
He stressed that chi l dren were different from adul ts, and that they could
be understood better by teachers if only the teachers would become
chi ldren themselves (Lebo, 1 955a).
I n the early stages of chi l d devel opment, P i aget bel i eved that the chi ld
must begin at the concrete l evel of experience before he could develop to
the abstract l eve l . P l ay i s the medium b y which the chi l d can concreti ze
1
2
his emotions and then general i ze them to the abstract (Piaget, 1 962).
Piaget, along w i th S i gmund Freud, bel ieved that the principle functi on of
play was adaptive, i n that i t al l owed the chi l d to ass i m i l ate and master
uni que and unpl easant experiences (Schaefer, 1 976). From these early
bel lefs, the beginnings of play as a therapeuti c techni que began to emerge.
The earl i est uses w ere those of Anna Freud and Melani e Kl ein, who
embraced the psychoanalytic approach.
From these di scoveri es of the therapeuti c use of play, and the
rea l i zation of the uniqueness of the therapeuti c needs of chi l dren,
professi ona l s have adapted p l ay i nto thei r own practi ces as a
l earni ng-expressive modal i ty (Ax l i ne, 1 947b; Freud, 1 954, 1 95 1 ; Kle i n,
1 955; Solomon, 1 938). Adul ts verbal i ze, whereas chi ldren express
themselves through fee l i ngs and explorat ions. Play therapy permi ts the
chi ld to rel ease h i s fee l i ngs and to explore his envi ronment and
relationships (Al l en, 1 942; Axl ine, 1 947b; Dorfman, 1 965; Erikson, 1 963;
Freud, 1 954; G inott, 1 96 1 ).
Statement of the Problem
.
Although counsel ors of ch i l dren w i l l usua l ly agree that p l ay is an
acceptable form of therapy for chi l dren, the l i terature found on the
3
subj ect is scattered and time consum ing to piece together. I t is difficult
to find material, espec i a l ly on theory and practi ce. which is not outdated.
More recently, there has been more research conducted, but i n the
l i terature. i t is usua l ly i solated from theory and practice. The material
deal l ng w i th theory. practice and research, ranging from books
(Al l en. 1 942; Axl i ne. 1 947b; Freud. 1 954, 1 95 1 ; Ginott, 1 96 1 ) to articles
(Dorfman, 1 965; Kl ein, 1 955; Lebo. 1 955a. 1 953; Solomon. 1 938) has been
summarized and catagori zed in this study.
Purpose of the Study
The purpose of this study is to summari ze and compl l e the l i terature
concerning the basic psychodynam i c theori es of play therapy, thei r
practical appl i cations in the field. and the research done, into a
comprehensive summary.
Most material on play therapy deal s w i th either theory, practi ce and
recently more research. but there have not been any clearly organi zed
studi es done to present the m aj or theories and to correl ate these w i th
thei r actual use by therapi sts i n the field. Also. the current research has
not been tied together to support these theories. or to produce evi dence to
support new findings rel ated to these theories. The purpose of my study is
4
@
to organize the l iterature on pl aytherapy into useable material , that is,
material which is tied together in one study to be used by students,
professors, professionals or others interested in the theory, practice and
research of p 1 ay therapy.
My intent is to present a chapter which incl udes a discussion of the
m aj or psychodynamic theories, and the various practical approaches used
by authorities in the fie l d. I wil l cite references and maj or contributors
in each field. The next chapter w il l deal w ith research. This wil l be
organized into sections of research deal ing with the different theories,
and studies done to promote new findings in the area of pl ay therapy. My
l ast chapter w il l provide a summary, conclusions, and a look at future uses
of and developments in the fie l d of p l ay therapy. A thorough bibliography
w il l be presented at the concl usion of the study.
Definitions of Terms
The term child therapy 1s used to describe al l therapeutic work done
with children, no m atter what theory or practice is used.
Play therapy is defined as the therapeutic use of play in an equipped
p l ay therapy room w ith a p l ay therapist present.
The play room is defined as a room equipped w ith a variety of special ly
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5
selected apparatuses, toys and materials which the chi l d can use as a
medium of expression.
The term individual play therapy i s used to descri be therapy which
occurs i n the p l ay room w i th one chi l d in the presence of a play therapi st.
The term group play therapy is used to descri be therapy which occurs i n
the play room w i th more than one chi l d i n the presence o f one or more play
therapists.
Areas of emphasis are the facets of the play experience which
i nf l uence process and outcome. The areas explored i n this study are:
a. Theoretical position of the play therapist
b. Spec i fi c techni ques used by each p l ay therapist
c. Process
1 . Stages of the play process
2. lim i ts set during play
3. Key e lements used (model ing, m i rrori ng, etc.)
4. Equipment
5. Famfly i nteractions
6. Setti ng
d. Types of chi ldren treated
e. Durati on of therapy
f. Termi nati on and outcome
6
Quest ions
S i m i l ar areas of emphasis are general ly used by therapi sts and wri ters
i n addressing the f i el d of play therapy. I n analyzing the i nformation
gathered, the important questions considered were:
1 . What are the m aj or pub l i shed theories and how do the major
therapists tn each area d i ffer in the i r own approaches to each of the areas
of emphasis def i ned above?
2. What research has been done to substantiate each of these theories
and support the practice of therapists in each area of emphasis?
S i gnificance of the Study
P l ay therapy i s recognized as a form of therapy for treating
emoti ona l ly and /or social ly malajusted chi l dren (Axl ine, 1 947b), but
l ittle has been done to compi l e the diverse array of l iterature in this area.
Theory, practice and research are rarely tied together to form a
comprehensive, i ndepth l ook at the s i gn i f icance of the f i el d. Usual ly,
theory and practice are tied together, but research is not i ncluded to
support i t, or research w i l l be disclosed and tied in w ith practice w i thout
attempting to i ntegrate this w i th theory. More and more l iterature is
7
being produced and research conducted w ithout any attempt to provide a
cl ear, comprehensive picture of this vast, expanding field. The
professional or student attempting to do research, or any party interested
in the field, has to do an extensive amount of searching and reading of
l iterature to find the m aterial pertinent to their area of research or
interest.
This study contains an organized approach to the theory, practice and
research of pl ay therapy. I t wil l provide an important reference source for
the professional, the student and the researcher. I t wil l assist those new
to the field with an overal l l ook at basic theories. I t wil l provide an
excel lent reference source for the professional seeking rel ated
information in a specific area of interest or concern which may rel ate to
his practice. I t w il l also provide the researcher w ith background
information necessary for the implementation of studies conducted in the
future.
Sources of Materials
Material s gathered for this study are l imited to those I was able to
l ocate through Education Resource I nformation Center (ERI C), Education
I ndex, Psychol ogical Abstracts, Dissertation Abstracts, Child Devel opment
8
Abstracts and Bibl i ography, b i b l i ographies, j ournals, textbooks, and
suggestions by selected therapists i n the field of play therapy. Data were
gathered from the l i braries at the University of Cal ifornia at Santa
Barbara, Cal l forn i a State University at Northridge and through the
inter-l l brary l oan system. I n addition, m aterials were col l ected through
Ventura County Li brary Servi ces, and from local therapi sts i n the field. I t
i s assumed that the above named sources have provi ded access to a
comprehensive amount of data on the subject.
Procedures for Col lection of Data
The historical approach was used for the col lection of data. Materials
were gathered through l ibrary systems as wel l as therapists currently
work i ng in the f i e l d of p l ay therapy. B i bl lographies were col lected from
books and articles on p l ay therapy as wel l as from the therapi sts
contacted. These bib l iographical entri es were col lected from an ERI C
search of Current I ndex to Journals i n Education and Resources i n
Education, Psychol ogical Abstracts, D issertati on Abstracts, Chi ld
Development Abstracts and Bibl i ography, Education I ndex, and Government
pub l i cati ons.
9
The combined bibl i ographies were taken to the l ibrary for further
research. Books and articles were read, and perti nent i nformation was
summari zed on i ndex cards. Many articles were partial ly or enti rely
xeroxed for future reference. The material was then organi zed i nto three
major areas: theory, practice and research. Theory and practice developed
into Chapter I I , whi l e research was separated i nto Chapter Ill.
Chapter I I
THEORI STS AND THE I R APPROACHES
Thi s chapter w i 1 1 deal w ith the l lterature concerni ng five maj or
areas of psychodynam i c theory devel opment: psychoanalytic, structured,
rel ationsh i p, nondi rective, and l im i t-sett i ng.
The various approaches of p l ay therapy have been focused on different
functi ons. Psychoanalyt i c, structured and relationship theories al l center
around p l ay as a form of communicat ion. Chi ldren expose their i nner
selves through p l ay and are assi sted by the therapi st in resolving conf l icts
and di sturbed emotions. Nond i rective therapies center on the chi l d w i th no
d i rection by the therapi st, i n the bel ief that the chi l d has the i nner desire
to be healthy, and given the right envi ronment, w i l l natura l l y resolve any
i mbalances. Then, the l im it-setting therapies focus on p l ay as a medium
through which other techni ques, such as catharsi s through symbol i sm, can
10
ll
(l
be appl ted.
Psychoanalyti c Approach
Sigmund Freud appears to have been the f i rst to apply psychotherapy to
chl ldren. He bel ieved that chi ld's p l ay shoul d be decoded, and stressed the
use of objects as a way of understandi ng fee l ings. He did not however
work directly w i th chtldren. H i s i nterest was directed more toward
observation as a means of exp l ai n i ng personal ity dynam ics and
development (Freud, 1 938). An example of thi s can be found i n h i s work
Analysis of a Phobja in a Five-Year-Old Boy ( 1 932), where he provi des the
boy's father w i th w ays of he lping Utt1e Hans work through h i s confl icts
and fears w h i ch are ref lected i n h i s phob i c reactions. Thi s case i s
considered the foundation from w h i ch i nterventions w i th chi ldren through
thei r parents and p l ay were developed. Further i ndepth study on thi s
theory can be found i n The Basjc Writings of Sigmund Freud (freud, 1 938).
A brief sum mary, found in the work of Kessler ( 1 966), i s presented here:
1 . Psychi c determi n i sm i s the sine qua non of all theories of
personal i ty development. Every thought, fee l i ng, or action has a couse,
and can be understood i n terms of antecedent conditions.
2. The same princ i pl es of behavior operate, under different
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12
conditions and to a different extent, in both normal and disturbed
individua ls. The difference between the mental l y il l and the normal is
a difference in degree, not of kind.
3. Psychoanal ysis establ ished the tremendous power of repressed
thoughts and feel ings. Children have an unconscious storehouse of
memories and fee l ings.
4. Anxiety and the mechanism of defense against it are a major
cause of repression to unconsciousness and account for much of what
seems irrational and unrealistic. This anxiety can arise from inner
confl ict as w e l l as from confl ict with the outside world. This concept
is necessary in the understanding of neurosis.
5. There is abundant evidence of the importance of past events in
present behavior, but psychoanal ytic investigations demonstrated the
long arm of unconscious memory, reaching back to the first five years
of l ife.
6. Sexual fee l ings and conflicts in early childhood are particular
sources of difficul ty, whether the reasons for these are biological ,
environmental , or a conbination o f both. (pp. 9- 1 0)
The work of von Hug-Hel l m uth, in 1 9 1 9, is believed to be the first use
of p l ay in the therapeutic setting. Though her use of p l ay was not
13
consi dered a p l ay techni que, she used p l ay as a substitute for free
associ ation by arrang i ng the p l ay rather than wai t i ng for spontaneous
si tuati ons to devel op. She also tried to become fam i l i ar w i th the chi l d's
natural surroundings and view him i n his own env i ronment (Hug-He1 1muth,
1 929).
Anna Freud and Mel an i e Klein l ater used S igmund Freud's analytica l
be1 1efs i n develop i ng their own d i stinct theories. They basical ly differed
i n thei r bel lefs regarding the development of the ego, superego, and i n
the i r methods of analysis. They also put thei r theories to practical use in
varying ways. In the 1 920's, Anna Freud began her work w i th chi ldren, and
moved to Vienna in 1 93 8 to develop her practice and teachi ng into the
"Vienna School of Chi ld Psychoanalysi s" (Freud, 1 95 1 ). Mel anie Klein began
her w ork i n Berl i n, but f ive years later, i n 1926, moved to London to
devel op her techni ques i nto the "Engl i sh School of Psychoanalys i s" (Klein,
1 932).
Anna Freud
Theory
The roots of Anna Freud's work with chi ldren stem from basic
psychoanalyt i c beHefs, but she d i d not focus on theory or techni ques as
much as she centered on the chi ld. She bel ieved that modif i cations and
14
adjustments of analyti c methods were necessary. Her reasoning for this
came from her real i zati on of the di fferences in the needs of adults as
apposed to the needs of chi l dren (Freud, 1 928).
She stressed the need for wooing the chi l d, and establ ishi ng a strong
rapport, almost a dependence on the therapist. She saw this as a
pretherapeut i c stage, which a l l owed the ch11d to develop confidence i n the
therapi st, to gain i nsi ght i nto the trouble, and to own the decision for
analysis rather than letting the dec i sion l ie w i th the adul ts. This would
a l l ow the chi ld to be analyzed on much the same grounds as an adul t. I n
adul t analysts, the c l ient al lys himsel f w i th the therapist against the
troublesome part of his bei ng, and thus the chi ld, i n much the same way,
shoul d devel op this strong dependence on the therapist i n order that
analysis m i ght be carri ed out i n the presence of thi s strong transference
(Freud, 1 928, 1 954).
Practice
I n the practice of her theory, she used three basic techni ques derived
from the school of psychoanalysis: history taking, dream interpretation,
and free associ ation. A h istory of the chi ld w as taken from the parents
i nstead of directly from the c l lent's memory, as would be done w i th
adul ts. This was done because of the chi ld's focus on the present, and the
15
l imited amount of time the chil d coul d derive a memory from. Dream
i nterpretation and free associ ation were also adapted for use w i th
children. She stated that a child dreams no less than nor more than an
adult, and by becomi ng ful ly involved with the chi l d, she pursued the dream
to i ts origins. I n free associ ation, she encouraged the chi l d to verbal ize
daydreams or fantasies, and suggested that the chi l d try to visual ize, or
see pictures. Toys were also used to hel p the child express himsel f, and
al l owed her to observe various reactions in rel ati onship to things and
people represented by the toys (Freud, 1 95 1 ; Murphy, 1 960; Schaefer,
1 983).
Anna Freud's abt l ity to adapt psychoanalyt i c theory to her practice with
children provided m aj or contributions to the area of child therapy. The use
of p l ay in her interactions w ith children al l owed this adaptation to create
a positive, successful means for working w i th troubled chi ldren.
Melanie Klein
Theory
Whereas Anna Freud advocated p l ay as mainly a medium through which
she could build an a l l iance with her young c l ient, Mel anie Klein used play
as a direct substi tute for verbal ization. She bel ieved that the young
chi ld's verbal skil l s were not ful ly developed enough to express the
16
complex thoughts and feel i ngs that the chi ld w as possible of experiencing,
and considered p l ay to be the chi l d's natural form of expression (Klein,
1 932).
Kle i n bel ieved that analysis was beneficial for al l chi ldren. Her basis
for this came from her ·be 1 i ef that the ch i1 d experiences comp 11cated
psychol og i cal confl icts (Kessler, 1 966). She stressed that the Oedipal
compl ex exists in the f i rst year of l ife, and that a harsh, cruel superego
devel ops i n the second quarter of the f i rst year before the resolution of
the Oedipal comp lex. Thus, a compl i cated psychi c system develops, and
the chi l d is capabl e of h i ghly sophisticated fantasies.
Klein based her studi es on the mother-chi l d fantasi es, and the strong
l ove drive accompanied by destructive tension. These studies included an
emphasis on the use of the p l ay of opposi tes i n the understandi ng of the
object rel ationshi p. She bel ieved that the chi ld divides the world i nto
good and bad objects which represent the protective and aggressive
tendencies. During states of crisis, the presence of an aggressive
tendency causes the chlld to unconsciousl y strive to repa i r any i maginary
i njury he thinks he has caused his mother. Klein bel ieved that to maintain
good mental heal th, i t was necessary for the chi ld to undergo early
analysis (Klein, 1 932, 1 955).
17
Pract i ce
Mel anie Klein, unl i ke Anna Freud and her need to devel op a close bond
w i th the chi ld , had no i ntroductory stage. She began her sessions w i th
direct i nterpretations of the child's behavi or. Duri ng her sessions, she
used three key elements from the psychoanalytic approach: free
associ ati on, expl oration of the unconsious, and analysis of the
fransf erence.
Her use of free associ ation consi sted of i nterpreting the preconscious
and unconscious meaning of each of the chi ld's p l ay activities. She
stressed both the use of toys and dramati cs i n discovering the fantasies,
anxieties, and defenses of the chlld. Klein's method of i nterpretation of
the chi ld's behavior through actions and words would compare w i th the
psychoanalyt i c techni que of free association used w ith adults w ho would
express themselves in a predomi nantly verbal m anner.
In her exploration of the unconscious, Klein would observe a play
situati on, then conclude and interpret what the child's use of certain toys
and movements meant to the child. She would express thi s to the chi ld
who would then rea l i ze that the toys stood for people and that the actions
he created stood for his feelings toward those people. She bel ieved that
the chi 1 d would gain insight i nto the i dea that part of his m ind was
18
unknown to him , and would begin to reahze the nature of the w ork that the
analyst was doing w ith him. This was her w ay of establ ishing the analytic
situation.
Klein, in keeping w ith the bel iefs of Sigmund Freud, bel ieved that the
child tranferred his early experiences, feel l ngs, and thoughts onto his
parents, then onto others. I n this case, the anal yst would be the object of
the transference, and would be abl e to analyze the past as we1 1 as the
unconscious part of the mind. Through reexperiencing early fantasies and
emotions, and being abl e to connect these to his parents, the child would
be abl e to rework these rel ations and diminish his anxieties (Klein, 1 932,
1 955).
Structured Approach
Though they differ s l t ghtly in their approaches, the four maj or
theorists in this area incl ude Gove Hambridge, David Levy, J. C. Solomon,
and Jacob Conn. Hambridge defined 1t as a technique used w1thin the
p l ayroom in which the therapist w as responsibl e for developing a series
of specific stim u l us situations which the ch11d would carry out
(Hambridge, 1955). Levy cal led this type of therapy "release therapy"
(Levy, 1 938), Solomon referred to it as "active p l ay therapy"
19
(Solomon,1938), and Conn saw i t as the "pl ay i nterview" (Conn, 1939). The
basi c theories behi nd each m an's approach are so sim i l i ar, that they are
combined i n the next sect ion. Each theorist's approach i s then explored
under a separate heading.
Theory
Structured therapy was derived from the psychoanalyt i c school of
thought. The main sim i l arity i s the therapi st's responsibi l i ty for a major
part of the therapeuti c experience. The bel i ef here is that the therapi st
knows more about the needs of the chi ld and i s capable of determ ining
what i s best i n the way of running the therapeuti c sessions. The sessi ons
are contro l l ed, and the chi ld p l ays out situations which w i l l bri ng about
the best opportuni ty for catharsi s and abreaction of certai n feel ings.
Their bel ief i s that through catharsi s and relearning, the chi ld can
reconstruct the areas which have deterred development.
Solomon stands out as hav i ng made one very important addition of his
own to thi s theory. Ego development was a primary concern of Solomon's.
He bel ieved that i f the ego had devel oped properly before the onset of a
traumati c si tuation, then the prognosi s wou l d be positive (Solomon, 1955).
20
Approach
David Levy
Levy developed a techni que ca11ed "release therapy" to deal w i th
ch1 1dren who had experienced a traumatic situation (Levy, 1938, 1939).
His emphasis was on recreating the i ncident through pl ay, using materials
and toys he provided. He usua11y provided only the toys which he thought
would help i n the recreati on, but the chi ld was not forced i nto any speci fic
play events. Levy wanted the chi ld to recreate the situation over and over
again unti l he cou l d assim i late the negative thoughts and feel i ngs
associ ated w ith the event. This type of therapy was derived from Sigmund
Freud's idea of repetition compulsion.
Levy divided release therapy i nto two k inds: speci fi c release therapy
and general release therapy. Spec i fi c rel ease therapy was used when three
very definite cond i t i ons existed: the chi l d had had the symptom for a
short durati on, the chi l d w as under ten years of age, and the problem was
not compl i cated by fam i ly i nteractions. The sessions would begin w i th
free p l ay, where the chi l d could become fam i l i ar w i th the new
surroundings and the therapist. When he fel t it was appropriate he would
begin to ask questi ons and introduce p l ay materials for the reenactment of
the spec i fi c situation.
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21
General rel ease therapy was used when the chi ld's problems had
stemmed from too m any demands m ade at too early an age. Levy would not
use structured events, but would use i t to mod i fy soci al behavior or to
release aggression.
J, C. Solomon
Around the same time that Levy was developing release therapy,
Solomon was devel op i ng a techni que cal led "active p l ay therapy" for use
w i th acti ng-out, i mpulsive chi ldren (Sol omon, 1938, 1940}. He felt that i f
the chl l d cou l d act out the rage or fear he w as experiencing, i t would have
an abreactive effect, because the chi ld wou l d be i n a safe environment
where the negative consequences expected wou l d not material lze. He not
only used thi s techni que for direct therapy, but he al so used it as a
di agnosti c tool and a research devi ce.
Solomon bel i eved that the chi ld could also redi rect the previously used
negative energy i nto more soci al ly acceptable behav iors. He stressed the
necesslty for the chi ld to differenti ate between present situat ions and
concern over past anxi eties and future consequences.
He saw the f irst stage of therapy as one w here fantasies were traced
back to the actual h istory of the chi ld. Thi s perm i tted a base from which
the chlld coul d experience p leasures along w i th negative aspects of the
22
event. I t a l l owed the chi l d to rea l i stical ly face the problem w i th new,
more posi tive sol utions.
Solomon used dol l s to represent si gn i f i cant others, i ncluding one for
himse l f. He be l ieved that the chi l d m i ght verba l i ze more easi ly through
the dol l s rather than face-to-face w i th the therapi st. He also thought that
practi c i ng verbal i zation w i th the dol l s would be helpful i n the
transferance of verba l izations to others.
Goye Hambrjdge
Hambridge·s techniques were very sim i lar to those of Levy, but
Hambridge used a m uch more structured approach. He set up a very
specific play setting, i n which the actual traumatic event was reenacted
(Hambridge, 1 955).
I n the f irst stage of the p l ay process, Ham bridge establ i shed a posi tive
rel ationship w l th the chi l d, and he made sure that the chi l d had developed
sufficient ego resourses before continuing on w i th the reenactment. Thi s
wou l d hel p prevent the chi l d from experiencing f looding, and the
regressi on and scattered emoti ons which accompany i t.
During the sessions of reenactment, he a l l owed the chi l d to choose
materials which were additional to the ones he had chosen for it. He
bel leved that an adequately equipped playroom, w i th cl i nical ly acceptable
23
materials, w as very i mportant. Thi s would a l low the chi ld to make
selections w h i ch were sign i fi cant elements of the play session.
After the reenactment had been worked through, Hambridge would make
sure that the chi ld was a l lowed free time. Thi s would give the chi ld time
to come together before leav i ng the p layroom, and entering a less safe
environment.
Hambridge stressed the i mportance of i nvolv i ng the parents i n the play
process i n order to assi st treatment. He informed the parents of the
i ncrease of aggressiveness w h i ch would occur because of treatment, and
helped them prepare for thi s, and other changes i n behavior which would
appear at home.
Jacob Coon
Conn used h i s technique, known as the "pl ay i nterview," to restore i n
the chi ld w hat w a s already there (Conn, 1 948). H e made extensive use of
dol l s to represent speci fic peopl e i n the sessions. Planned l i fe si tuations
were used, and the each successive interview was based on the way the
chi l d used the toys and dol ls.
He w as very stri ct about the fact that the sessions were not for
entertai nment, but for therapeutic use. He conveyed thi s to the chi ld, who
qui ckly reali zed that there was a defin i te focus to each session. Coon
24
geared his sessi ons to the i ndivi dual chi l d by maki ng use of the chi ld's
i nteractions w i th the materials, and he used h i s techni que w i th chi ldren
who had vary i ng problems: fearful ness, timid and dependent behavior,
castration fears, and anxiety.
Conn a l so w orked w ith the parents in the p l ay sessions. He usually saw
the parents before the first session, and let them tel l their story. Then,
he would i nv i te them i nto the sessions w h i l e their chi l d reviewed what
had been 1earned during the sessions.
Rel at ionship. Approach
A number of p l ay techniques devel oped i n the 1 930's were grouped
together, and cal l ed "re l ationsh i p therapies." The basi s for these therap ies
was derived from the work of Otto Rank ( 1 936). He stressed the
i mportance of birth trauma i n the devel opment of the i ndividual . Hi s
bel ief was that the stress experienced at b i rth caused a fear of
i ndividual i zation, and l ead the person to cl i ng to past experiences. When
view i ng the cl f ent, transference and past events were not as i mportant to
him as were the real i ties of the c l ient-therapi st relationsh i p and the
cl ient's exi stence i n the here and now.
Jessie Taft, Frederi ck Al l en, and Clark Moustakas al l adapted h i s
25
\1
viewpoi nts to work w i th chi l dren i n therapy. They bel ieved that the
negative effects of the trauma of bi rth created a Jack of abi l ity i n chi l dren
to form posi tive rel ati onships. The chi ldren who were affected by thi s
usua1ly became very dependent, often c1 i nging chi 1dren, and developed
strong attachments to their immedi ate sign i ficant other, and were unable
to successful ly rel ate to others.
Despite the tendency to p lace l ess i mportance on transference and on
the past experiences of the chi l d, the fo11owers of relationshi p therapies
sti l l maintained close ties w i th the psychoanalyt i c approach. They j ust
placed less emphasi s on these areas, and more emphasi s on the
chi ld-therapist re l ationship.
Jessie Taft
Theory
Taft's emphasis was existential. She concentrated on the rel ationship
between the chi l d and the therapi st, and the chi l d's abi Hty to use thi s
rel ationship i n a n effective way (Taft. 1933 ). She bel ieved that the
process produced a union between the chi ld and the therapist that the chi l d
had not experienced since weaning or birth, and that thi s uni on held the
curative power of the therapeut i c process.
•
26
Approach
During the sessons, Taft concentrated on the rel ationship that was
developing, not the materia l s used. Her main emphasis was on the
termination of each session and the termination of treatment. She
bel ieved that these separations were reenactments of the trauma at birth.
I f the ch11d coul d successful ly reexperience the separation from the womb
at birth, then he coul d l earn to survive future separations. She viewed the
termination of the therapy process as an integral part of the process
because the l ength of the process and the termination date were
predetermined.
Erederi ck Allen
Theory
Al l en bel leved that the trauma experienced by the ch11d was more
physiological . He emphasized this because of the extreme physical and
biologica l changes that the ch11d went through during the time of birth
(Al l en, 1 942). Birth, according to Al l en, was the final point of separation,
and began a time of differentiation for the ch11d.
The rel ationship establ ished between the therapist and the ch11d was
determined by Al l en to be the most important aspect in the successful
27
outcome of treatment. He felt that this would help the child develop a
sense of value in an ever changing world.
Approach
Allen believed that therapy began when the therapist entered into a
caring and supportive relationship with the ch1Jd, which allowed the child
to gain confidence and a sense of self-worth. During the sessions, he did
not believe in the chlld becoming dependent on him, nor did he take over
responsibility for the growth of the chf l d. He accepted the chi1d as he was
at this stage of development, and centered on the difficulties which
concerned the child most.
Al l en became involved w ith the child, and allowed the child to express
himself freely. He did not, however, bel leve that the child should be
considered a friend. He set 1 1m its for the child when appropriate.
Parental involvement was stressed by Allen. He would bring the chlld
and the parent to therapy at the same time. The child would be seen in
therapy, wh1Je the parent would be seen by a case worker. Thus, they were
being seen together for the same cause, but they w�re also differentiated.
Clark Moustakas
Theory
Moustakas worked on helping the child w ith developing his individual
28
sel f, and w i th exploring posi tive interrel ationsh ips. He used the secure
atmosphere of the p l ay therapy setting, and the safe relati onship that was
establ i shed w i th the chf ld for carry i ng out h i s therapeutic goal s
(Moustakas, 1 959).
H i s theory centered around the bel i ef that the birth process was a
never-endi ng experi ence. He contended that a l l peopl e go through thi s
grow i ng process o f p a i n and happiness w hen i nvolved i n a rel ationship
w i th another human being.
Moustakas used the strength of h i s rel ationsh i p w i th the chi ld to help
the chi l d cope w i th the struggle between accepting his needs of
dependency and h i s need to develop h i s autonomy. He strongly bel ieved i n
focusing o n feel ings i n the here and now, and not o n symptoms and causes.
Approach
Moustakas bel i eved the rol e of the therapi st was one of openness and
sel f-awareness. He always started h i s work w i th the chi l d by beginning
where the chi ld was, and by emi nating a feel i ng of unqual i fied acceptance,
respect, and fai th.
He showed h i s respect by always al l ow i ng the chi ld to make h i s own
deci si ons. The p l ay sessions were not structured, and the chi l d was
a l l owed to lead the way, choosing h i s own toys and materials. Moustakas
29
always l i stened to the chi ld, and encouraged h i m to expl ore h i s own
thoughts and feel ings.
Even though the chi l d was al l owed to lead the way, Moustakas did not
bel ieve in bei ng passive. He be11eved in setting l im i ts when necessary, and
i n taki ng an active part in the activi t i es of the chi ld. He would also take
part i n the p l anning of activities I f the chi ld w i shed.
Nondi rective Approach
The roots for nondi rective p l ay therapy came from the work of Carl
Rogers. He developed the cl ient-centere·d (nondi rective) approach to
therapy w i th adul ts. H i s approach grew out of his therapy w i th
i ndiv i duals, and h i s theory on personal i ty change. A thorough summary of
thi s approach can be found i n Theories of Personality (Hal l and
Undzey, 1957). The part of Roger's theory from which Virgi n i a Axl ine
devel oped her nondi rective p l ay therapy i s very i mportant. The fol low i ng
i s a summary of thi s part of Roger's theory:
1. Characteristics of the infant: An i nfant perceives h i s experience
as real i ty and has predisposi tion toward activation i n real ity
perceived. He behaves w ho1i stica11y and engages i n a val u i ng
process, mov i ng toward those things posi tively valued.
30
2. Development of the sel f: Part of the actual izing tendency i n the
chi l d becomes different i ated and sym bo l l zed i n awareness, which is
descri bed as sel f-experience. Thi s awareness becomes elaborated,
through i nteraction w ith the envi ronment i nto a concept of sel f.
3. Need for posit ive regard: This universal trait develops from
awareness of sel f. I t is reciprocal i n that w hen the person sati sfies
another, it becomes sel f-sati sfying. Thus the expression of positive
regard by a si gn i ficant other can be more compel l ing than the
organi sm i c val uing process.
4. Development of the need for sel f regard: This i s a l earned need
devel op i ng out of sel f experi ence and the need for posi tive regard.
5. Development of conditions of worth: I n the event that the person
experiences only uncondi t i onal positive regard, no cond i t i ons of worth
devel op. Self regard shoul d be unconditional --hypothetica J Jy fu1 1y
function ing.
6. Development of i ncongruence between sel f and experience:
Experiences are perceived selectively. Those in accord are accurately
sym bol i zed to awareness; those not i n accord are denied awareness.
7. Development of discrepanci es i n behavi or: Some behaviors
maintain sel f concept so as to make congruence. Others are
31
unrecogn ized or di storted so as to be consistent.
8. Experience of threat and the process of defense: An incongruent
experience i s perceived as threatening. This leads to the development
of anxiety. R i gi d i ty, d i stortion, and i naccurate perception of real i ty
result due to om i ssion of data and i ntensional i ty.
9. Process of breakdown and d i sorgani zation: When a person has a
l arge degree of i ncongruence between sel f and experience and the
defense i s unsuccessful , d i sorganization resul ts.
1 0. Process of rei ntegration: Because the person i s able to
experience condi t i ons of worth i n an atmosphere of unconditional
acceptance an i ncrease in unconditional sel f-regard occurs. (Rogers,
1 959, pp. 1 84-256)
Virginia Axl ine
Theory
I n i nterpreting Carl Roger's theory, Virgin i a Axl ine suggested that as
the chi l d separates from his environment, he begins to form a reciprocal
rel ationship w i th that environment. She a l so bel ieved that the chi ld forms
a sense of sel f because of the way he views the perceptions of si gnifi cant
others (Ax l i ne, 1 947b).
Axl ine had two basi c bel iefs about the nature of people. First, she said
32
that the chi l d loves grow ing and constantly strives for i t, and second, the
i ndividual has basi c needs which he i s constantly trying to sati sfy. She
felt that the i ndividual's ultimate goa l i n l ife was one of complete
rea l i zation.
She bel i eved that the well-adjusted chi ld was one who w as able to
meet h i s needs by directing h i s own behavior through eval uation,
selectivity, and app l i cation. Of the malajusted chi ld, Axl lne sai d that the
chi l d had not met h i s needs, and that he used devi ous means in order to
gai n sat i sfaction of these needs. He then devel oped an i nner struggle for
growth as h i s efforts were blocked by h i s env i ronment. This caused the
chi l d to lose h i s sense of rea l i sm i n h i s percept ions and his experiences.
For the chi l d to devel op a sense of unconditional sel f worth, Axl lne sai d
that i t was necessary for the cht l d to experience conditions o f worth
w i thin an atmosphere of uncondi t i onal acceptance. Thi s would al l ow the
chi l d to move from d i sorgani zation to reorgani zation. The crucial point of
her nondirective therapy was that she bel ieved that the chi l d had w i thin
himself al l the necessary components for grow i ng and changing. Because
of thi s, she sai d that the chi l d would move where he needed to when al l
the conditions were ri ght, and that i t was the responsi bi l i ty of the
therapi st to prov i de these conditions.
33
Approach
Nondirective therapy is not a technique. The process in nondirective
therapy occurs because the therapist has incorporated a certain set of
values into his personal ity, and he bel ieves that the individual has the
inner capacity for growth, decision m aking, and motivation for moving
forward. Axl ine ( 1 947b) states that there are eight basic principles by
which the therapist should conduct himself in the p l ay therapy process:
1 . The therapist must develop a warm, friendly rel ationship with
the child, in which good rapport is establ ished as soon as possible.
2. The therapist accepts the child exactly as he is.
3. The therapist establ ishes a feel ing of permissiveness in the
rel ationship so that the child feel s free to express his feel ings
completely.
4. The therapist is a lert to recognize the feel ings the child is
expressing and reflects those back to him in such a m anner that he
gains insight into his behavior.
5. The therapist maintains a deep respect for the child's abil ity to
solve his own problems if given an opportunity to do so. The
responsibil ity to make choices and to institute change is the child's.
6. The therapist does not attempt to direct the child's actions or
34
conversation i n any manner. The chi l d leads the way; the therapi st
fol lows.
7. The therapist does not attempt to hurry the therapy along. I t is a
gradual process and is recognized as such by the therapist.
8. The therapi st establ i shes only those l im itations that are
necessary to anchor the therapy to the world of real ity and to make the
chi l d aware of his responsi bi l i ty in the relationsh i p. (pp.75-76)
Axl i ne bel i eved that the relationshi p establ i shed w i th the chi l d would
enable him to use the capacities from w i th i n to deal more constructively
w i th his environment and w ith those around him. In establ i sh i ng thi s
rel ationsh i p, she fel t that the most natural l anguage for the child was
play, and that w i thin the safe, accept i ng envi ronment, the chil d would
real ize the power w i th i n him self. As the chi ld was freed of anxiety and
tension, he would have more energy for forward growth. As the child
became more congruent and real l stic, then others i n h i s envi ronment would
respond di fferently, and the circu l ar destructive process would become a
positive process.
Axl l ne suggested that therapy shoul d take pl ace in an equipped
p l ayroom, but in som e cases a corner of a room wou l d be adequate. The
room should include: soundproofing, a sink with running water, protected
35
w i ndows, wal l s and floors that coul d easi ly be cleaned, and accessible
shelves for materi a l s. She did not beH eve i n the therapi st choosing the
materia l s that the chi ld would interact w i th, but let the chi ld do the
choosing. She did, however, have a l i st of equi pment which she fel t would
be sui tabl e for the p l ayroom. This H st can be found in Play Therapy: The
I nner Dynamics of Childhood (Ax l i ne, 1 947b, p. 57). She stressed that each
session shoul d be a new beginning, so an materials shoul d be cleaned up,
and repaired or rep laced if damaged.
Axl ine worked w i th a l l di fferent chi ldren w ith various ages and
difficult ies, i nclud i ng physi ca l handi caps. She even concluded that a
chi ld's teacher coul d be both teacher and therapi st to a chl l d. Axl i ne also
expressed the bel ief i n play therapy as a way to hel p chi ldren w i th above
average i ntel H gence w ho were hav i ng d i fficu l ty i n readi ng (Ax l i ne,
1 947b, 1 949a).
Famny i nvolvement i n the p l ay therapy process was seen by Axl ine as
benefi cial i n some instances, but not necessary for successful therapy to
occur (Axl i ne, 1 955). She thought that i t could hel p as a means of
sel f-di scovery for the parents and the chi ld, and she suggested that the
fam i ly j o i n the chi ld i n the p layroom setting. She fel t that
36
sel f-di sclosure coul d provide the chi ld w ith an opportunity to see h i mself
i n ways w i thin the fam i ly that he had not previously seen.
L i m i t-Setting Approach
I n 1949, Ray Bixler wrote an art i cl e titled Limits Are Therapy, and
brought about a new area in p l ay therapy. Bixler, and l ater Haim Ginott
( 196 1), stressed that l im i ts were an i ntegral part of the play therapy
process.
Other therapi sts bel ieved i n l im i ts, but not as the primary part of the
process. Axl i ne ( 1947b) and Moustakas (1959) bel ieved that the setting
of l im its a l l owed the process to occur and that it added unique dimensi ons
to the process. Two therapi sts, Dorfman ( 1965) and Schi ffer ( 1952), who
did activity therapy more than p l ay therapy, set very few l im i ts.
Ray Bixler
Theory
Bixler suggested that the development and enforcement of l im i ts i n the
therapy session was the primary veh i cle of change. He stated that the
therapi st shoul d set l i mi ts w h i ch he or she w as comfortable w i th. Bixler
( 1949) out l i ned f ive l i mi ts which he thought were basi c to the play
therapy sessions:
37
1. The child shoul d not be a l l owed to destroy any property or
facilities in the room other than p l ay equipment.
2 The chil d shoul d not be al l owed to physical ly attack the
therapist.
3. The chl l d shoul d not be al lowed to stay beyond the time l fm it of
·the interview.
4. The chl l d shoul d not be al l ow ed to remove toys from the
p l ayroom.
5. The ch11d shoul d not be al lowed to throw toys or other material
out of the w indow. (p.2)
Bixler bel ieved that wel l -defined l im its a l lowed the rel ationship
between the therapist and the chl l d to be more comfortable. He saw that
unclear l im its were m isused by the poorly adjusted child, and caused
insecurity to arise.
Approach
Bixl er set l im l ts at the time of the act. He did this so that the child
would learn what he w as permitted to do while he explored his
environment and his rel ationship. Bixler ( 1949) suggested the fol lowing
steps in setting l im its during the p l ay sessions:
( 1) ref lect the desire or attitude of the chl ld
38
(2) verbally express the l im i t
(3) provi de an acceptable al ternative, and f i nal ly
( 4) control by physical means i f necessary. (p. 4)
Bixler would remove the chlld from the playroom i f he needed to
enforce the l im i t of aggressi on toward h imse l f. He sai d that chi ldren
would l eave the p l ayroom w i th a sense of rel i ef because their aggression
had been control l ed. Setti ng these l i mi ts in the playroom a l so helped
contro l behavi or at home.
Haim Gjnott
·
Theory
Ginott fol l owed the bel iefs of Bix ler, but had some vary i ng 1 1m its to be
set for the chi l d i n the p l ay therapy setting. A complete di scussion of
these l im i ts and h i s reasons for using them can be found i n h i s book Group
Psychotherapy with Chi1dren· The Theory and Practice of Play Therapy
( 1 96 1 ). The fol l ow in g i s a summary of the l i m its Ginott suggests:
1 . He sets a f i rm time l im i t, usual ly about f i fty m inutes.
2. He does not adv i se that p layroom equ ipment be taken home.
3. L i m i ts are set i n order to prevent d i struction of property.
4. The chi l d i s not a l l owed to attack the therapi st because i t could
cause emot ional di stress for the chi ld and interfere w i th the
39
therapist's re lationship w ith him.
Ginott has a l so developed specific guidel ines for his approach to
setting 1im its. G inott ( 1 959) states the four step sequence as fo11ow s:
1 . The therapist recognizes the child's feel ings or w ishes and he lps
him to verbalize them as they are.
2. He states cl e arly the l imit on a specific act.
3. He points out other channel s through which the feeling or wishes
can be expressed (he provides al ternatives).
4. He helps the cht ld to br1ng out the feel ings of resentment that
are bound to arise when restrictions are invoked. (p. 1 07)
Approach
Ginott ( 1 96 1 ) bel ieved that the rel ationship w ith the child should begin
on a very structured basis. He did not bel ieve in letting the child make the
decision on whether or not to go to therapy. I f the child did not want to
come to the p layroom, he would extend his hand and take the child or a l l ow
the mother to take him.
He stressed the importance of preparing the mother in advance of the
first session so that she wou l d understand what w as expected of the child
in the p layroom, and so that she coul d hel p the child deal w ith the new
situation. He m ade sure that the parents were ful ly aware that the
40
p l ayroom was not a p lace to have fun, but a pl ace where their chi ld could
learn to make deci si ons, to gai n i ndependence, and to express his thoughts
and fee l i ngs in a constructive way.
Ginott fel t that the therapi st shoul d proj ect a feel ing of empathy,
respect, and acceptance. He wanted to convey to the chi ld that thi s
rel ationsh i p would be l ike n o other rel ationsh i p h e had experi enced.
Summary
Thi s chapter has presented five major psychodynami c theori es of play
therapy. The bel iefs and approaches of the major theori sts i n each area
w ere di scussed. I t i s hoped that the sources cited w i l l provi de further,
more i ndepth i nformation concerni ng each theory or theori st i nvolved.
Using the h i stor i ca l approach, a summary of the early theori sts was
given. The wri tings of Anna Freud and Melanie Klein were di scussed and
compared. Structured theory and the various techniques of David Levy, J.
C. Solomon, Gove Hambridge, and Jacob Conn were summarized. The work
of the relationsh i p theori sts, Frederi ck Al l en, Jessie Taft, and Cl ark
Moustakas, was l ooked at. C l fent-centered therapy, developed by Carl
Rogers, was described, and i ts adaptation by Virgin i a Axl ine i nto
nondirective p l ay therapy was explored.
Chapter I l l
RESEARCH RELEVANT TO MAJOR APPROACHES
The hi story of research conducted i n regard to play therapy has been
one of controversy. I n 1966, Masl ing made reference to research i n p l ay
therapy as being nonexi stent. Whi le thi s was not true, research at the
time was not produci ng much evidence to show posi tive outcome using
p l ay therapy techni ques (Gi nott, 1961, pp. 135-158; Levi tt, 1957, 1963).
Much of the problem may be due to the bel ief that therapeuti c work i s
anal ogous to art, rather than science, and cannot be tested using val i d and
rel iable methods. I n play therapy, the age of the chi ld, and the emphasi s
on the use of play rather than words as the chi ld's form of communication,
have posed even further concerns.
Harter ( 1983) has wri tten an articl e which descri bes the sci entifi c
hypotheti co-deductive method i n compari son w i th research conducted i n
41
42
p l ay therapy. She compares each stage of the scienti fi c method w i th i ts
counterpart i n play therapy research. She associates the deductive method
of a hypothesi s fol l owed by experimentation w i th the i nductive method of
observation cul m i nati ng i n an general bel ief or hypothesis. The next step
of experimentation, she correl ates w i th the i nterpretati ons made by the ·
therapi st duri ng therapy. She bel leves that acceptance of the hypothesis,
vehement deniel, or p l ay disruption on the part of the chi l d means
confirmation of the hypothesi s, and no reaction means that the hypothesis
has been rejected. Her analogy coul d give i nsight i nto the use of
observations and case studi es as research.
I n the l ast twenty years, possibly parti al ly due to thi s controversy,
greater interest has been expressed in the pursuit of conducting val i d and
rel i ab�e research i n play therapy. As a result of thi s, more studies have
appeared w h i ch attempt to make use of a more scienti fi c method of
research.
Observation and case studies are an accepted form of research, but thi s
chapter w i l l attempt to present research which fits a more sci enti fi c
model . Some case studies and observat ions are i ncluded. Additional
observations and case studies for each major theory can be found by
referring to Chapter I I . Ci tations of works done by theori sts i n each area
43
w ill lead the reader to this information.
Studies Using Psychoanalytic Theory
As discussed in Chapter I I , the psychoanalytic approach to play therapy
has roots which extend back to Sigmund Freud and his work with adults.
From his work, Anna Freud and Melanie Klein became the leaders in
adapting his theory to play therapy for children. Many observations and
case studies have been reported to document their work. I n recent years,
there have been some studies done w hich make use of the scientific
method of research.
Two case studies, that were both documented, reported positive
changes in behavior using play therapy based on psychoanalytic tenets.
The first, recorded by Fries ( 1 937), reports success with a young child
following the direct teachings of Anna Freud. The second was reported by
Fraiberg in 1 962, and was conducted w ith a four-year-old boy. Fraiberg
followed the teachings of Anna Freud, but believed that the therapist
should not be responsible for the educative nature of the work, which
Freud describes as necessary.
I n 1 974, a study done by Feigelson, attempted to show the importance
of the central role of play therapy in the psychoanalysis of children. Case
44
examples were used, along w i th comparisons of the di fferences i n resul ts
of using p l ay and not using play i n the psychoanalysi s of these chi ldren.
Resul ts are reported that show the c�ses usi ng p l ay to be more effective.
I n 1 980, a case study was reported by Rei nelt and Brei ter, in which
psychoanalyti c-oriented p l ay and behavi or modifi cation techni ques were
combined to help a boy w i th tri chot i l lomania. Even though a scientific
model was not used, behavi or was measured, and results were recorded.
This case i nvolved an analyti c diagnosis of the probl em, and a
clarificati on of the symptoms suffered by a three-year-ol d boy.
Analyti c-ori ented p l ay w as used to hel p the chi l d verba l i ze his fee l ings,
and to give the therapist an i dea of the underlying problems causi ng this
behavi or. Behavior modifi cation techniques were then used to hel p the boy
change his pattern of behavi or.
The boy was determ i ned to have tri choti l lomania, which was defined as
the e l i m i nation of tension, l earned behavior, or a symptom of
psychodynam ic confl i cts. The boy was observed as constantly pul l ing out
his own hair. The analyti c i nterpretation stated that the hai r pul l i ng
served two purposes: sel f punishment for destructive aggression w i shes
against his parents, and a w ay to give himself a feel i ng of existence. To
help the boy overcome this condi t i on, the therapi st used pieces of the
45
boy's own hai r to caress his l ips. The bel i ef was that the caressing hair
would become a substitute for unsati sfied needs for love and tenderness.
The behavior of the boy was moni tored, and the hai r pul l ing was
determ i ned to become progressively less as the hair was used to caress
h i s l ips. Eventual ly, the boy was determ i ned to be cured through the use of
psychoanalyti c p l ay therapy and behavi or therapy techniques.
Studies Using Structured Theory
Structured therapy i s an offshoot of psychoanalyti c theory. The main
sim i l iarity is the bel ief i n the development of the personal i ty. The
di fference l ies in the structured therapi sts' bel ief that the therapist is
more knowl edgeable about the needs of the cl ient, and should therefor
structure the p l ay session to meet the needs of the cl ient.
I n 1955, Conn reported a case using h i s technique of the p l ay interview.
He worked w i th a thirteen-year-ol d boy who suffered from fears of
castration. The boy was passive and very dependent. The play interview
consi sted of the use of dol l s, through which Conn encouraged the boy to
di scuss h i s fears. H i s report ends w i th a fol low-up study done fifteen
years later, w hen the boy had reached twenty-nine. Conn reports that he
had assumed, and mainta i ned a mascu l i ne identi ty. H i s report does not,
46
however, go i nto much detai l regarding events i n the boys l i fe between
therapy and the fol l ow-up study. This leaves some question as to whether
or not there coul d have been other i ntervening factors.
Homefi eld ( 1 959) d i d a study i nvolving the effect of role-pl aying, along
w i th the use of masks, as a therapeuti c technique for chi ldren who
stuttered. His hypothesis basical ly fol l owed the bel iefs of Ham bridge
( 1 955), w ho sai d that reenactment of a specif i c traumati c si tuation could
bri ng about catharsis. Homefleld used l im i ted reexposure of the chi ld to
emoti onal events w i th which the chi ld had been unable to cope.
His study i nvol ved ei ghteen boys of elementary school age who
stuttered. He divided the boys i nto three even groups who met once weekly
for one hour of role-play ing. One group never used masks, one group used
masks only i n the f irst few weeks of therapy, and the other group used
m asks for the enti re e i ght-week period. The boys were a l l shown the same
pictures, and asked to tel l what they thought was happening.
Homefield bel i eved that the perm issive atmosphere provided a
comfortabl e place i n which the role-pl ay i ng could occur, and that through
role-pl aying the chi l d could speak more f luently than during regular
speech. His conclusions reported that the chi ldren who wore the masks for
the first sessi ons of the rol e-pl aying began to speak more fluently than
47
the ones who did not, and the ones who wore them for the entire time had a
greater potential for speaking more f l uently more quickly.
I n 1 98 1 , a research study was conducted using brief intervention
therapy for behavioral ly disturbed pre-school chil dren. Bidder, Gray, and
Pates used positive learning and structured p l ay techniques in treating
nine chil dren aged 1 4 to 36 months. The cht ldren were diagnosed as having
poor concentration, sleep disturbances, and poor cooperation with parents.
This group of children was compared with a no-treatment group of six
normal age-matched chl ldren.
The experiment began with a two-week observation period, fol lowed by
the experimental group receiving treatment in their homes for a
seven-week period. Of the original nine famil ies, two did not cooperate,
and one child improved spontaneously. Videotapes were made of each
group at play for fifteen m inutes prior to the therapists' visits. Analysis
of the videotapes showed significant preintervention between-group
differences in concentration, cooperation, and positive comments made by
the parents and children. A fol low-up study showed no significant changes
in behavior since the termination of the experiment.
I n 1 982, a research study was conducted by Bleck and Bleck to show the
significance of structured p l ay in improving behavior of disruptive
48
chi l dren. The subj ects were selected by thi rd grade teachers i n thirteen
elementary school s, who each selected three boys and three girls in their
cl asses who represented disruptive behavior. One hal f of the students was
assi gned to a seven-week structured play group, and the other hal f was
assi gned to a no-treatment control condition.
The treatment began w ith early group sessions focusing on social
i nteraction and sel f-disclosure. Thi s was desi gned to i ncrease group trust
and cohesiveness, awareness of sel f and others, and an understanding of
feel ings. The next set of sessions dea1t w i th di sruptive school behavior,
i ts consequences, and al ternati ves to such behavior. The final sessions
focused on cooperation, sharing, and feedback.
The students i n the i ntervention group showed signi fi cant i mprovement
on the Coopersm i th Sel f-Esteem I nventory and on the Di srespect-Defi ance
factor of the Devereux School Behavi or Rating Scal e. The results were
determ i ned to indicate that structured p l ay can have a posi tive effect on
attitudes of disrupt ive chi ldren.
I n 1 983, a study was reported by G lanzer in which toys were used as
ai des i n treating a twelve-year-old paranoid ch i l d. The treatment
consi sted of twenty-two sessions i n which the therapi st employed
sceno-test methods and gui ded i magery. The parents were also given ten
49
trai ning sessions. Glanzer reported posi tive outcomes, w i th a f ive-year
follow-up study reporting permanent recovery.
Studies Using Relati onship Theory
Relationsh i p theory developed out of the work of Otto Rank ( 1 936), who
believed that the trauma of birth lead the chi ld to a fear of
i ndivi dualization, and to a need for clinging to past experiences.
Therapi sts i n thi s area made use of the relationship they established w i th
the chi ld to help the chl ld learn to successfully relate to others.
I n 1 955, Moustakas conducted a study to help determ i ne the process
whi ch the chl ld goes through i n relationsh i p therapy. The study i nvolved
the frequency and i ntensi ty of expression of negative atti tudes of nine
well-adj usted and n i ne di sturbed four-year-old chi ldren. The chl ldren
were matched on i ntelligence and sociometri c background.
The treatment consi sted of four play therapy sessions for each chi ld
w i th the same therapi st. Verbatim records were kept for each chi ld's
statements. From the f i rst and thi rd sessions, a ll st of 24 1 negative
atti tudes were selected and rated i n terms of intensi ty of feelings
expressed.
50
Results i nd i cated that both groups of chi ldren were determ i ned to have
expressed about the same types of negative atti tudes, but the di sturbed
group expressed a si gn i fi cantly greater amount of negative atti tudes w i th
a more di ffuse and persuasive manner. Moustakas concluded that di sturbed
and wel l -adjusted chi ldren coul d be more clearly di fferentiated on the
basi s of i ntensity of negative atti tudes rather than on frequency. He
suggested that as the therapy progressed, the negative atti tudes of the
di sturbed chi ld became si m i 1 ar to those of the we1 1 -adjusted chi ld, and
that the negative atti tudes were expressed more clearly and less
frequently.
Another study done i n 1 955 was conducted by Moustakas and Schalock.
The emphasi s of the study was on the relationsh i p establ ished between the
therapi st and the chi ld, and i ts effect on the chi ld. Two groups of
four-year-old nursery school chi ldren were used. Group A consi sted of
three girls and two boys considered to be normal, and Group B consi sted of
four boys and one girl w i th seri ous emotional problems.
Each chi ld was seen i nd ividua l l y by the same therapi st for two
forty-minute p l ay sessions. w i th a three-day interval between sessions.
A report of the conclusi ons i ncluded a summary of observations of
behavi or and a summary of anxiety-hosti l i ty rati ngs for both the therapi st
51
and the two groups of chl l dren, an analysis of i nteraction sequences
initiated by the therapist and the chl l dren's responses to them, and an
analysis of i nteracti on sequences initiated by the chi ld. Moustakas and
Schalock concluded that the i nteracti on on the part of the therapist was an
i mportant factor i n the p l ay therapy process.
I n 1 967, Pothier reported a case study of a chi l d who was having
di ffi cul ty establ i sh i ng positive relationships w i th others. The goal of
therapy for thi s eight-year-old boy was to provide the boy w i th a
concerned, consi stent re lationship, whi ch would then al low him to
transfer thi s behavi or onto other rel ationshi ps. Pothier concluded that
play therapy was valuable in hel p i ng this boy ful fi l l his own needs through
estab11shi ng posi tive relationships.
Studies Using Nondirective Theory
Borrow i ng from the basic bel iefs of Carl Rogers, Virginia Axl ine
devel oped nondi rective p l ay therapy for chi l dren. Fundamental to her
work, w�s her bel i ef that the chi l d had w ithin himself al l the necessary
components for grow i ng and changing. She bel ieved that the chi ld would
move where he needed to when al l the conditions where ri ght, and that it
was the sole responsi bl ity of the therapist to provide that envi ronment.
52
il
Many case studi es reporting successful interventi ons using
nondi rective p l ay therapy have been reported. Andriola ( 1 944) reported
excerpts from successful therapy w i th a tim i d ten-year-old boy.
Landi sberg and Snyder ( 1 946) exam i ned therapeutic resul ts of cases with
four chi l dren, aged five to six, of which two were reported successful and
one incomplete. They suggested that, for younger chi Jdren, nondi rective
p l ay therapy m i ght be catharti c rather than i nsi ghtful or educative. Axl i ne
( 1 948) has descri bed her successful work w i th a four-year-old girl, and a
young boy. Axl ine ( 1 964) also devoted an entire book to her successful
work w i th a boy named D i bs.
Two case studi es reported successful outcomes using nondi rective play
therapy to hel p chi ldren w i th speech problems. I n 1 946, Reynert reported
the successful case of a seven-year-old chi ld who overcame a speech
problem of stuttering. I n 1 953, Dupent, Landsman and Valentine
conducted a study of a chi ld who was suffering from delayed speech,
where emotional di sturbance was considered to be a causative factor. The
researchers held forty-one i nterviews w i th the two therapists i nvolved,
and discovered that the therapi sts had observed i mprovement in emotional
adjustment and in i ntel l i gi bi l i ty of speech, w i thout any speech therapy
being provided.
·
.
53
I n the treatment of reading probl ems, nondi rective therapy has been
reported as hav i ng successful results. I n 1 945, Bixler conducted a seri es
of twenty i nterv i ews which reported successful outcomes in he I p i ng a
chi ld to read, when no readi ng i nstruction was given. Axl i ne ( 1 947a,
1 949b ) presented case studi es w i th chi ldren of above average inte l l i gence
who had reading d i ff i cult i es. One of the chi l dren substi tuted the fantasy
world of readi ng for fri ends, and the other two had difficulty readi ng. She
bel i eved that the chi l dren's emotional problems were causi ng the reading
difficulty, and that given the opportuni ty to help themse lves, they would.
She bel i eved that the nondi rective p l ay therapy experi ence gave them that
opportuni ty.
Some research studi es have also been conducted to show the positive'
outcome of nondi rective p l ay therapy. Axl ine ( 1 949a) researched the
correlation of p l ay therapy and i ntel l i gence. F i fteen six- and
seven-year-old chi ldren d i agnosed as hav i ng behavior and speech problems
were seen for e i ght to twenty sessions. Pre- and posttest therapy scores
were used to divide the chi l dren i nto three groups: cht 1dren who showed
no change in inte l l igence scores after therapy, cht 1dren who showed
sign i f i cant changes i n inte J J i gence scores after therapy, and chi ldren w ith
average i ntel l igence scores before and after therapy.
54
Axl ine reported that the chi ldren w ho did not have a raise i n
i ntel l i gence scores were the ones who did not comp lete therapy, and the
ones who had an i ncrease had completed the therapy sessions. She stated
that the reason for the i ncrease in i nte l l i gence w as not due to the play
therapy i tsel f, but to the emotional release that took place, and a l l owed
them to function at thei r true capacities. Axl ine i ncluded the thi rd group
of average inte l l i gence chi 1dren to show that behavior probl ems stem more
from emoti onal defi c ienc i es than from mental deficiencies.
I n 1 953, Cox researched the effects of nondi rective play therapy on the
i nterpersonal relati onshi ps and i ndiv i dual adjustment of two groups of
orphanage chi 1dren. N i ne chi l dren who were matched for age, sex,
resi dential placement, adj ustment, Themati c Apperception Test scores,
and soc iometric measures were placed i n each group. The sample was
representative of the orphanage popul ation.
The experimental group was g iven ten weeks of play therapy. The
control group received no therapy. Both groups were retested at the end of
therapy, and agai n f ifteen weeks l ater. The adjustment scores and peer
rati ngs of about hal f of the chi ldren i n the experimental group showed
i mprovement. The control group showed no gains.
I n 1 958, Dorfman researched the personal ity outcomes of nondi rective
55
play therapy w i th chi l dren aged n i ne to twelve, who had average
i ntel l igence, and who were consi dered by thei r teachers to be mal adj usteq.
Her primary hypotheses included: personal i ty changes occurred during a
therapy period, they did not occur in the same chi l d during a no-therapy
period, and they did not occur i n the control group. Her secondary
hypotheses included: effective therapy can be done i n a school setti ng, and
therapy i mprovements occur w i thout parent counsel ing i n spi te of the
emotional dependence of chi ldren upon parents.
The basic experimental desi gn which she used was the pre-test and
post-test. I t i nvolved observation during three time periods for the
therapy group of twelve boys and f ive girls. They were tested over three
time peri ods which were pre-therapy or control peri od, therapy period, and
fol l ow-up peri od. The experimental group was tested over four time
periods: thirteen weeks before therapy, immediately pri or to therapy,
immediately after therapy, and a year to a year and a hal f after therapy.
She used psycholog i cal tests, therapist j udgments, and fol low-up l etters
in order to i nvestigate the outcome.
Dorfman found that rel iabl e test i mprovements occurred
simul taneously w i th a series of therapy sessions. She also found that
t i me alone did not produce rel i able i mprovements on tests. Her secondary
56
hypotheses were also supported.
I n 1 978, a research study was conducted by Schm i dtchen and HobrOcker
to determ ine the eff i c iency of nondirective play therapy. Treatment
consi sted of nondi rective p l ay therapy conducted in a guidance cl inic. Pre­
and posttest scores for e ighteen chi l dren nine to thirteen years of age
were compared to the scores of two control groups. The experimental
group showed sign i f i cant i mprovement i n social and i ntel lectual
flexibi l i ty, as wel l as a decrease i n anxiety and behavior di sorders. I n
addition, social sel f-concept approximated the mother concept of the
chi l dren.
The effect of p l ay therapy was predicted on the basis of individual
i nput data represented by test scores and behavior di sorder assessments.
Analysis proved val i d i n 55% of the i mprovement prognosis (3 1 % of the
controls), and 2% of the deteriorati on prognosis ( 1 6% of the controls). I t
was also suggested that more experimental therapy and additional
treatment of the parents m i ght further improve the resul ts.
Studies Usi ng L i m i t-Setting Theory
L i m i t-setting as a therapeuti c approach was f i rst explored by Bixler
( 1 949). The approach centered around the bel iefs that 1 imits were
57
fundamental to the p l ay therapy process, and that they were the primary
vehicle of change. No research studi es were found on the effects of
l im i t-setting i n p l ay therapy, however, three studi es were found which
attempted to identify the types of l im i ts to be set.
I n 1 96 1 , Ginott and Lebo developed a questionnai re which was designed
to f i nd the correlation between the use of l i mi ts and the theoretical
ori entati on of the professional s assessed. The questionnaire contained
flfty-four discrete 1 i m i ts, and the respondents consisted of 1 00
therapi sts who consi dered themselves to be psychoanalytic, forty-one
nondirective, and e ighty-si x from other school s.
From the resul ts of the questi onnaire, Ginott and Lebo concluded that
the therapists from the different approaches al l employed a s i m i l ar
number of l im t ts i n thei r work w i th chi l dren. Some di fferences were
noted i n the kinds of l im i ts set.
Another study done by G i nott and Lebo ( 1 963), i nvestigated the most
used l im i ts in p l ay therapy. A questionnai re on l i mi ts was sent to 227
p l ay therapi sts ( 1 00 psychoanalytic, forty-one nondi rective, and
e ighty-six from other school s). The questionnai re asked them to identi fy
from the l ist the l im i ts that they most frequently used w i th chi ldren from
the ages of three to ten. From the resul ts of thi s questionnai re, they
58
establ ished a l i st of the most used and least used l im i ts i n play therapy.
Rhoden, Krenz, and Lund ( 1 98 1 ) conducted a study which repl icated and
extended the studies done by G i nott and Lebo. Thei r study consisted of 1 3 1
play therapists questioned. The resul ts showed a notably siml l ar pattern
of l im i t-setting among the therapi sts of di fferent orientations, sex, and
years of experi ence. Stat i stica l ly sign i f i cant differences were found
between therapists of different orientations for only 7 out of the 54
l im i ts surveyed. Rel atively few l im i ts were never used, and at least half
were ordinari ly used. They also reported a notabl e decrease i n differences
of l im i ts used over the n i neteen-year period since the first study was
completed.
Summary
An i ntroducti on to the h istory of research i n p l ay therapy was
discussed, which i nc luded a l ook at the l ack of research produced i n the
past as evidence of pos i tive outcome. The controversy over therapy being
analogous to art and not science, l ead to a discussi on of case studi es and
observati ons as being val i d and rel i ab l e forms of research. The young age
of the chi l d and his nonverbal form of communication were discussed as
posi ng other various concerns in research being conducted.
59
The use of observation and case studies as a va1 1d form of research was
di scussed as being acceptab l e, but w i th an emphasis bei ng pl aced on the
desire for more research to be conducted using a scientific model. The
controversy over the l ack of research and the need for va1 1 d research
studies to be conducted was discussed as possibly having lead to a greater
number of studies bei ng produced in the l ast twenty years.
The historical approach was used i n reporti ng case studi es and
observations, w i th a greater emphasis being pl aced on reporti ng research
using a more sci ent i f i c model. Al l thi s was then separated i nto major
theory areas, and summari zed. I n some cases, studies were grouped
together i f they were based on a common area of emphasis under a major
theory. The reader w as also referred to ci tations of major theori sts i n
Chapter I I for the bul k o f case studies and observations under each major
theory.
�
----
Chapter I V
SUMMARY AND CONCLUS IONS
Summary
I n summary, l iterature deal ing w i th p l ay therapy was surveyed,
summari zed, and organized. The historical approach was used for the
col l ection of data. Materials were col l ected through the sources provi ded
by l ibrary services as wel l as therapi sts i n the field. The material found
was divided i nto theory, approach, and research. Theory and approach were
organi zed i nto Chapter I I , whi l e the material found on research was
organi zed i nto Chapter I I I .
After an extensive search of the l i terature, i t was found that material
was scattered throughout books and j ournals. Much of the l iterature deal t
w i th ei ther theory and/or practice, and had been wri tten when play
therapy f i rst became popular. This l i terature discussed play therapy for
60
61
chi l dren from the standpoi nt of past therapy done w i th adul ts. More
recent l i terature tended to show more work bei ng done speci f i ca l ly w i th
chi ldren. The l i terature found on research was usua l ly i n case study form,
which had not been tied in w i th ei ther theory or practice, and seemed to
beg i n w i th the theory l evel. Some research was found that made an
attempt to provi de studi es done usi ng the sc ientific model (movement
from hypothesis to research to theory). This research apparently came out
of a need for more accountab1 1 ity on the part of the play therapists, but it
sti l l proved to show very i nconclusive evidence.
Concl usions
Even though more recent l i terature has been written, and more rel iable
research attempted, there is sti l l a need for more comprehensive works to
be written i n the major areas of theory development. I t is i mportant for
some works to i nc lude theory, practice, and research. This would provide
the reader w i th i nformation to hel p develop a cl earer picture of what has .
been attempted, what has been done to achieve the specific goal s, what
has been accomp l fshed, and what measures were taken to i nsure that the
outcome was achi eved through the speci f ied means.
The fol l ow i ng are recommendations for providing more val i d and
rel iabl e research deal ing w i th outcome in p l ay therapy: behaviors and
62
personal i ty tra i ts need to be more specifica l ly def i ned, changes i n
behaviors rather than i n personal i ty need to b e more clearly defi ned, and
devi ces used to measure speci f ic behaviors need to be more careful ly
devel oped and used. The process in p l ay therapy also needs to be looked at
more careful ly in rel ation to the outcome. Methods for eval uati ng the
process, i nc l uding assessment of activity i nvolved and i nteractions taking
p l ace w i th i n the sessions, need to be developed.
Few scattered studies have been done i n areas of emphasis w i thin the
p l ay therapy process. More research is needed i n the fol low i ng areas:
m aterials, i nc l ud i ng toys, the p layroom setti ng, H m i ts, therapist
behav iors, parental i nvolvement, tra i n i ng mode l s for development of ski l ls
i n professi onal s and others, i ncluding parents, durati on of therapy, and the
termi nati on process. At thi s t ime, a thorough revi ew and summarization
of al l the l iterature and research done i n a l l these areas so far, would be a
very helpful beg i nn ing.
From this beg i nn i ng, an organi zed approach to theory development could
beg i n to grow. More i nformation coul d be comp1 Jed as therapy and research
are conducted, and thi s i nformation cou l d be p l aced on computers for
organization, storage, and future reference. Here, research and theory
coul d become an i ntegral part of the therapy process. As more i nformation
63
is added, i t could be compared, ana l i zed, and used for further developments
in the field of play therapy.
B l BL I OGRAPHY
Al l en, F. H. ( 1 942). Psychotherapy with children New York: Norton.
Andriola, J. Release of aggressi ons through p l ay therapy for a
teo-year-ol d patient at a chi ld guidance c l in ic. Psychoanalytic Review,
.ll, 7 1,-80.
Axl i ne, V. M. ( 1 947a). Nondi rective therapy for poor readers. Journal of
Consulting Psychology, .ll, 6 1 -69.
Axl ine, V. M. ( 1 947b ). Play therapy: The inner dynamics of chi1dhood.
Boston: Houghton-M i ff l i n.
Axl i ne, V. M. ( 1 948). Some observat i ons of p l ay therapy. Journal of
Consulting Psychology, 12, 209-2 1 6.
Axl ine, V. M. { 1 949a ). Mental deficiency, symptom or disease? Journal of
Consul ting Psychology, .U, 3 1 3-327.
Axl i ne, V. M. ( 1 949b ). P l ay therapy: A w ay of understanding and hel p i ng
reading problems. Chi ldhood Education, 2.6., 1 56- 1 6 1 .
Axl i ne, V. M. ( 1 955). Group therapy as a means of self-discovery for
parents and chi ldren. Group Psychotherapy, .8., 1 52- 1 60.
Axl ine, V. M. ( 1 964). Dibs· In search of self. Boston, Houghton-Miffl i n.
Bi dder, R. T., Gray, 0. P., & Pates, R. M. { 1 98 1 , January-February). Brief
intervent i on therapy for behaviora l ly disturbed pre-school chi l dren.
Child Care, Health & Development, 1( I ), 2 1 -30.
Bixler, R. H. { 1 945). Treatment of a readi ng problem through nondi rective
p l ay therapy. Journal of Consulting Psychology, .9, _1 05- 1 1 8.
Bix ler, R. H. { 1 949). L i m i ts are therapy. Journal of Consulting Psychology,
.u, 1 - 1 1 .
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65
Bleck, R. T. & B l eck, B. L. ( 1 982, December). The disruptive chi l d's play
group. Elementary School Guidance and Counseling, 11(2), 1 37- 1 4 1 .
Conn, J. ( 1 939). The chi l d reveals hi mse l f through play. Mental Hygiene,
ZJ, 49-69.
Conn, J. ( 1 948). The p l ay i nterv i ew as an i nvesti gative and therapeutic
procedure. Nervous Chil d, 1, 257-286.
Coon, J. ( 1 955). P l ay i nterv i ew therapy of castration fear. American
Journal of Orthopsychiatry, 25, 747-754.
Cox, F. E. ( 1 953). Sociometric status and i odjvidual adjustment before and
after p l ay therapy. Journal of Abnormal Psychol ogy, �. 354-356.
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